MEDICARE: SSM HEALTH CARE OF OKLAHOMA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	1-7683	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2147052	OTHER		PK

General Provider Information

NPI Number	:	1316354814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SSM HEALTH CARE OF OKLAHOMA INC

Provider Business Mailing Address
First Line	:	3400 S DOUGLAS BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73150-1001
Country	:	US
Telephone Number	:	405-772-4034
Fax Number	:	405-772-4042

Provider Business Practice Location Address
First Line	:	3400 S DOUGLAS BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73150-1001
Country	:	US
Telephone Number	:	405-772-4034
Fax Number	:

Authorized Official
Title or Position	:	DOP
Name	:	CHARLES DREYLING
Credential	:
Telephone Number	:	405-272-6393

Provider Enumeration Date	:	07/16/2014
Last Update Date	:	11/22/2016

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