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Organization
SAINTS MEDICAL GROUP, LLC
Active
Organization
SAINTS MEDICAL GROUP, LLC
Active
Other names
SSM Health Medical Group Shawnee Kickapoo Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
SHASTA RENE MANUEL (VICE PRESIDENT - FINANCE)
(405) 272-7282
Entity
Organization
Contact information
Practice address
3700 N KICKAPOO AVE, SHAWNEE, OK 74804-1707
(405) 273-6383
(405) 273-3748
Mailing address
3700 N KICKAPOO AVE, SHAWNEE, OK 74804-1707
(405) 273-6383
(405) 273-3748
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207Y00000X
Otolaryngology Physician
—
NULL
207Y00000X
Otolaryngology Physician
—
—
231H00000X
Audiologist
—
NULL
231H00000X
Audiologist
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
NULL
363AM0700X
Medical Physician Assistant
—
NULL
363AM0700X
Medical Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
04/08/2021
Last updated
03/27/2024
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