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General NPI Number Information
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NPI Number | 1770178170
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Entity Type | Organization
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Legal Business Name | SHAWNEE MEDICAL CENTER CLINIC, INC
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Dates
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Enumeration Date | 03/08/2021
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 1102 W MACARTHUR ST
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City | SHAWNEE
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State | OK
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Zip | 74804-1743
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Country | US
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Telephone | 405-272-7311
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Fax | 405-272-6962
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Provider Business Mailing Address
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Address Line | 1102 W MACARTHUR ST
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City | SHAWNEE
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State | OK
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Zip | 74804-1743
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Country | US
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Telephone | 405-272-7311
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Fax | 405-272-6962
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Authorized Official
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Title or Position | 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 | 207RX0202X
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Taxonomy Name | Medical Oncology 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 | 2471R0002X
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Taxonomy Name | Radiation Therapy Radiologic Technologist
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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