Provider Demographics
NPI:1033113097
Name:ST. ANTHONY SHAWNEE HOSPITAL, INC
Entity Type:Organization
Organization Name:ST. ANTHONY SHAWNEE HOSPITAL, INC
Other - Org Name:SSM HEALTH ST. ANTHONY HOSPITAL - SHAWNEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT-CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SKILLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-878-8110
Mailing Address - Street 1:1102 W MACARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1743
Mailing Address - Country:US
Mailing Address - Phone:405-273-2270
Mailing Address - Fax:405-878-8101
Practice Address - Street 1:1900 S GORDON COOPER DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801
Practice Address - Country:US
Practice Address - Phone:405-273-2270
Practice Address - Fax:405-878-8101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. ANTHONY SHAWNEE HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-08
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2162273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100740840BMedicaid
OK000370149001OtherBCBS
OK000370149001OtherBCBS