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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1811442197
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	:	SUITE 100
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73150-1001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 S DOUGLAS BLVD
Second Line	:	SUITE 100
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73150-1001
Country	:	US
Telephone Number	:	405-272-7223
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/SSM HEALTHA CARE OF OKLAH
Name	:	MR. JOE HODGES
Credential	:
Telephone Number	:	405-272-7345

Provider Enumeration Date	:	08/17/2016
Last Update Date	:	08/17/2016

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