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General NPI Number Information
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NPI Number | 1467967604
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Entity Type | Organization
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Legal Business Name | SSM HEALTHCARE OF OKLAHOMA, INC
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Dates
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Enumeration Date | 12/11/2017
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Last Update Date | 12/11/2017
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Provider Practice Location Address
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Address Line | 9 N BRYANT AVE
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City | EDMOND
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State | OK
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Zip | 73034-6307
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Country | US
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Telephone | 405-285-4011
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Fax | 405-285-0096
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Provider Business Mailing Address
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Address Line | 9 N BRYANT AVE
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City | EDMOND
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State | OK
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Zip | 73034-6307
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Country | US
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Telephone | 405-285-4011
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Fax | 405-285-0096
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Authorized Official
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Title or Position | INSURANCE CREDENTIALING SPECIALIST
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State | OK
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