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
—
—
207Y00000X
Otolaryngology Physician
—
—
231H00000X
Audiologist
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
04/08/2021
Last updated
03/27/2024
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