Organization
SHAWNEE MEDICAL CENTER CLINIC, INC
Active
Parent organization
SSM HEALTH CARE OF OKLAHOMA, INC.
Other names
SSM Health Medical Group Shawnee Ortho
Organization subpart
Yes
Provider details
NPI number
Legal business name
SSM HEALTH CARE OF OKLAHOMA, INC.
Authorized official
CRYSTAL L PENA (CREDENTIALING SPECIALIST)
(405) 272-7452
Entity
Organization
Contact information
Practice address
3315 KETHLEY RD, SHAWNEE, OK 74804-9638
(405) 273-5801
(405) 878-3794
Mailing address
3315 KETHLEY RD, SHAWNEE, OK 74804-9638
(405) 273-5801
(405) 878-3794
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
11/25/2019
Last updated
11/25/2019
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