Healthcare Provider Details

I. General information

NPI: 1780471847
Provider Name (Legal Business Name): STILLWATER MEDICAL CENTER AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 W 6TH AVE
STILLWATER OK
74074-4306
US

IV. Provider business mailing address

1323 W 6TH AVE
STILLWATER OK
74074-4306
US

V. Phone/Fax

Practice location:
  • Phone: 405-372-1480
  • Fax:
Mailing address:
  • Phone: 405-372-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DENISE ADRIENNE WEBBER
Title or Position: CEO
Credential:
Phone: 405-742-5230