Provider Demographics
NPI:1801190061
Name:SSM HEALTH CARE OF OKLAHOMA, INC
Entity Type:Organization
Organization Name:SSM HEALTH CARE OF OKLAHOMA, INC
Other - Org Name:ST ANTHONY HERITAGE FAMILY MEDICINE
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: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:405-737-6871
Mailing Address - Fax:405-733-4281
Practice Address - Street 1:6908 E RENO AVE
Practice Address - Street 2:BUILDING 1
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-2128
Practice Address - Country:US
Practice Address - Phone:405-737-6871
Practice Address - Fax:405-733-4281
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTHCARE OF OKLAHOMA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-03
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty