MEDICARE: SHAWNEE MEDICAL CENTER CLINIC, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207LP2900X	Pain Medicine (Anesthesiology) Physician
2	207Q00000X	Family Medicine Physician
3	207R00000X	Internal Medicine Physician
4	207RG0100X	Gastroenterology Physician
5	207RP1001X	Pulmonary Disease Physician
6	207RR0500X	Rheumatology Physician
7	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1841832755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAWNEE MEDICAL CENTER CLINIC, INC

Provider Business Mailing Address
First Line	:	3012 ARLINGTON ST
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-3073
Country	:	US
Telephone Number	:	580-272-0715
Fax Number	:	580-272-0772

Provider Business Practice Location Address
First Line	:	3012 ARLINGTON ST
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-3073
Country	:	US
Telephone Number	:	580-272-0715
Fax Number	:	580-272-0772

Authorized Official
Title or Position	:	PROVIDER ENROLLMENT/INS CREDENTIAL
Name	:	CRYSTAL L PENA
Credential	:
Telephone Number	:	405-272-7452

Provider Enumeration Date	:	10/11/2019
Last Update Date	:	10/11/2019

Similar Medicare Providers

1912111238 — TROY R NORRED MD PC
Practice Location Address:

3012 ARLINGTON ST
ADA, OK
74820-3073

Practice Phone: 405-948-4040
Practice Fax:

1760716518 — SAINTS MEDICAL GROUP, LLC
Practice Location Address:

3012 ARLINGTON ST
ADA, OK
74820-3073

Practice Phone: 580-272-0715
Practice Fax: 580-272-0771

1801141478 — MIDWEST CITY HMA PHYSICIAN MANAGEMENT, LLC
Practice Location Address:

3012 ARLINGTON ST
ADA, OK
74820-3073

Practice Phone: 580-272-0715
Practice Fax: 580-272-0771

1972991081 — TROY R NORRED MD PC
Practice Location Address:

3012 ARLINGTON ST
ADA, OK
74820-3073

Practice Phone: 580-272-0715
Practice Fax: 580-272-0771

1396932265 — WALGREEN CO
Practice Location Address:

1005 ARLINGTON ST
ADA, OK
74820-4036

Practice Phone: 580-272-0283
Practice Fax: 580-272-0281

1922743079 — DANI BOUGH-DAVID BRECHEEN CM II
Practice Location Address:

1308 CRADDUCK RD
ADA, OK
74820-8442

Practice Phone: 580-320-5181
Practice Fax: 580-332-8803

Directions to “SHAWNEE MEDICAL CENTER CLINIC, INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.