Healthcare Provider Details

I. General information

NPI: 1326555434
Provider Name (Legal Business Name): SSM HEALTH CARE OF OKLAHOMA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 06/16/2018
Certification Date:
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: 405-942-4000
  • Fax: 405-942-9204
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL L PENA
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 405-272-7452