Provider Demographics
NPI:1386016962
Name:SHAWNEE MEDICAL CENTER CLINIC, INC.
Entity Type:Organization
Organization Name:SHAWNEE MEDICAL CENTER CLINIC, INC.
Other - Org Name:ST. ANTHONY PHYSICIANS MEEKER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTANT/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-395-3931
Mailing Address - Street 1:PO BOX 849
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74802-0849
Mailing Address - Country:US
Mailing Address - Phone:405-279-4281
Mailing Address - Fax:
Practice Address - Street 1:102 W. CARL HUBBELL BLVD.
Practice Address - Street 2:
Practice Address - City:MEEKER
Practice Address - State:OK
Practice Address - Zip Code:74855
Practice Address - Country:US
Practice Address - Phone:405-279-4281
Practice Address - Fax:405-279-4285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty