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General NPI Number Information
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NPI Number | 1295493955
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Entity Type | Organization
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Legal Business Name | SSM HEALTH CARE OF OKLAHOMA INC
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Dates
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Enumeration Date | 11/30/2021
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 2825 PARKLAWN DR
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City | MIDWEST CITY
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State | OK
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Zip | 73110-4201
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Country | US
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Telephone | 405-610-4411
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Fax |
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Provider Business Mailing Address
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Address Line | 7106 SOLUTIONS CTR
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City | CHICAGO
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State | IL
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Zip | 60677-7001
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Country | US
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Telephone | 855-989-6789
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Fax | 314-344-7281
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT
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Name | CRYSTAL L PENA
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Credential |
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Telephone | 405-272-7452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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