Provider Demographics
NPI:1659666899
Name:SSM HEALTHCARE OF OKLAHOMA
Entity Type:Organization
Organization Name:SSM HEALTHCARE OF OKLAHOMA
Other - Org Name:ST ANTHONY MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
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:405-272-5500
Mailing Address - Fax:405-272-5550
Practice Address - Street 1:6205 N SANTA FE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-7537
Practice Address - Country:US
Practice Address - Phone:405-272-5500
Practice Address - Fax:405-272-5550
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTHCARE OF OKLAHOMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-16
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty