1437561180 NPI number — SSM HEALTH CARE OF OKLAHOMA, INC

Table of content: (NPI 1437561180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437561180 NPI number — SSM HEALTH CARE OF OKLAHOMA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SSM HEALTH CARE OF OKLAHOMA, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ST ANTHONY PHYSICIANS TELEPSYCHIATRY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437561180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 269064
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73126-9064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-231-3857
Provider Business Mailing Address Fax Number:
405-272-7977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 CENTRAL PARK W
Provider Second Line Business Practice Location Address:
SUITE 36
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10025-7145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-231-8866
Provider Business Practice Location Address Fax Number:
405-272-8599
Provider Enumeration Date:
05/29/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PENA
Authorized Official First Name:
CRYSTAL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
INSURANCE CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
405-272-7452

Provider Taxonomy Codes

  • Taxonomy code: 2084P0804X , with the licence number:  30382 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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