1467967604 NPI number — SSM HEALTHCARE OF OKLAHOMA, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467967604 NPI number — SSM HEALTHCARE OF OKLAHOMA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SSM HEALTHCARE 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 CANCER SPECIALISTS OF OKLAHOMA @ EDMOND
Provider Other Organization Name Type Code:
3
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:
1467967604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 N BRYANT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73034-6307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-285-4011
Provider Business Mailing Address Fax Number:
405-285-0096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 N BRYANT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73034-6307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-285-4011
Provider Business Practice Location Address Fax Number:
405-285-0096
Provider Enumeration Date:
12/11/2017

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: 207RH0003X , 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)





Copyright © 2007-2024 www.npivalidator.com