Healthcare Provider Details

I. General information

NPI: 1659886893
Provider Name (Legal Business Name): SSM HEALTHCARE OF OKLAHOMA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 PROFESSIONAL CIR
YUKON OK
73099-6314
US

IV. Provider business mailing address

1614 PROFESSIONAL CIR
YUKON OK
73099-6314
US

V. Phone/Fax

Practice location:
  • Phone: 405-265-1900
  • Fax: 405-264-1100
Mailing address:
  • Phone: 405-265-1900
  • Fax: 405-264-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

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