Healthcare Provider Details

I. General information

NPI: 1336546621
Provider Name (Legal Business Name): SSM HEALTH CARE OF OKLAHOMA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 NW 9TH ST SUITE 100
OKLAHOMA CITY OK
73102-1070
US

IV. Provider business mailing address

535 NW 9TH ST SUITE 100
OKLAHOMA CITY OK
73102-1070
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-4226
  • Fax: 405-272-8407
Mailing address:
  • Phone: 405-272-4226
  • Fax: 405-272-8407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL L PENA
Title or Position: INSURANCE CREDENTIALING SPECIALIST
Credential:
Phone: 405-272-7452