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General NPI Number Information
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NPI Number | 1487677456
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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 | 07/25/2006
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 1000 N LEE AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73102-1036
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Country | US
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Telephone | 405-231-3857
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Fax | 405-272-4948
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Provider Business Mailing Address
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Address Line | PO BOX 958210
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City | SAINT LOUIS
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State | MO
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Zip | 63195-8210
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Country | US
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Telephone | 405-231-3857
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Fax | 405-272-7977
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Authorized Official
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Title or Position | VP FINANCE
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Name | SHASTA RENE MANUEL
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Credential |
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Telephone | 405-272-7282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) 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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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