Provider Demographics
NPI:1659886893
Name:SSM HEALTHCARE OF OKLAHOMA, INC
Entity Type:Organization
Organization Name:SSM HEALTHCARE OF OKLAHOMA, INC
Other - Org Name:ST ANTHONY CANCER SPECIALISTS OF OKLAHOMA @ YUKON
Other - Org Type:Doing Business As
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 1:1614 PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6314
Mailing Address - Country:US
Mailing Address - Phone:405-265-1900
Mailing Address - Fax:405-264-1100
Practice Address - Street 1:1614 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6314
Practice Address - Country:US
Practice Address - Phone:405-265-1900
Practice Address - Fax:405-264-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty