Organization
ST. MARY'S PHYSICIAN ASSOCIATES, LLC
Active
Other names
St. Mary's Podiatry Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
TODD EVANS (VICE PRESIDENT)
(610) 768-3300
Entity
Organization
Contact information
Practice address
1908 N 14TH STREET, SUITE 203, PONCA CITY, OK 74601-2039
(580) 249-3929
(580) 234-3301
Mailing address
PO BOX 844737, ATT: IPM CREDENTIALING, DALLAS, TX 75284-4737
(855) 298-6628
(903) 416-1701
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
11/05/2015
Last updated
06/28/2019
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