1013196831 NPI number — SSM HEALTH CARE OF OKLAHOMA INC

Table of content: (NPI 1013196831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013196831 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:
Provider Other Organization Name Type Code:
6
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:
1013196831
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2011
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:
405-272-4948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6201 N SANTA FE AVE
Provider Second Line Business Practice Location Address:
SUITE 2020
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73118-7538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-272-5433
Provider Business Practice Location Address Fax Number:
405-272-5435
Provider Enumeration Date:
10/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAIN
Authorized Official First Name:
SYNOVIA
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CLIENT ACCOUNT ADMINISTRATOR
Authorized Official Telephone Number:
405-231-3824

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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