Provider Demographics
NPI:1639689375
Name:SSM HEALTH CARE OF OKLAHOMA INC
Entity Type:Organization
Organization Name:SSM HEALTH CARE OF OKLAHOMA INC
Other - Org Name:ST ANTHONY PHYSICIANS BEHAVIORAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURACE 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 1:608 NW 9TH ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1015
Mailing Address - Country:US
Mailing Address - Phone:405-231-3000
Mailing Address - Fax:405-231-3073
Practice Address - Street 1:608 NW 9TH ST STE 1100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1015
Practice Address - Country:US
Practice Address - Phone:405-231-3000
Practice Address - Fax:405-231-3073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty