Provider Demographics
NPI:1013196831
Name:SSM HEALTH CARE OF OKLAHOMA INC
Entity Type:Organization
Organization Name:SSM HEALTH CARE OF OKLAHOMA INC
Other - Org Name:ST ANTHONY PRIMARY CARE PHYSICIANS NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLIENT ACCOUNT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SYNOVIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:BAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-231-3824
Mailing Address - Street 1:PO BOX 269064
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9064
Mailing Address - Country:US
Mailing Address - Phone:405-231-3857
Mailing Address - Fax:405-272-4948
Practice Address - Street 1:6201 N SANTA FE AVE
Practice Address - Street 2:SUITE 2020
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-7538
Practice Address - Country:US
Practice Address - Phone:405-272-5433
Practice Address - Fax:405-272-5435
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTH CARE OF OKLAHOMA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-29
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty