Provider Demographics
NPI:1437561180
Name:SSM HEALTH CARE OF OKLAHOMA, INC
Entity Type:Organization
Organization Name:SSM HEALTH CARE OF OKLAHOMA, INC
Other - Org Name:ST ANTHONY PHYSICIANS TELEPSYCHIATRY
Other - Org Type:Other Name
Authorized Official - Title/Position:INSURANCE CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-272-7452
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:405-272-7977
Practice Address - Street 1:333 CENTRAL PARK W
Practice Address - Street 2:SUITE 36
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7145
Practice Address - Country:US
Practice Address - Phone:405-231-8866
Practice Address - Fax:405-272-8599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK303822084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty