Provider Demographics
NPI:1891245882
Name:SSM HEALTH CARE OF OKLAHOMA, INC
Entity Type:Organization
Organization Name:SSM HEALTH CARE OF OKLAHOMA, INC
Other - Org Name:ST ANTHONY EAST-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 1:3400 S DOUGLAS BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73150-1001
Mailing Address - Country:US
Mailing Address - Phone:405-231-8888
Mailing Address - Fax:405-231-8885
Practice Address - Street 1:3400 S DOUGLAS BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73150-1001
Practice Address - Country:US
Practice Address - Phone:405-231-8888
Practice Address - Fax:405-231-8885
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTH CARE OF OKLAHOMA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty