Healthcare Provider Details

I. General information

NPI: 1619260411
Provider Name (Legal Business Name): ST ANTHONY SHAWNEE HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 W MACARTHUR ST
SHAWNEE OK
74804-1743
US

IV. Provider business mailing address

1102 W MACARTHUR ST
SHAWNEE OK
74804-1743
US

V. Phone/Fax

Practice location:
  • Phone: 405-878-8110
  • Fax: 405-878-8101
Mailing address:
  • Phone: 405-878-8110
  • Fax: 405-878-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SHASTA MANUEL
Title or Position: VP FINANCE
Credential:
Phone: 405-272-7282