Organization
ST. MARY'S PHYSICIAN ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TODD EVANS (CFO)
(610) 768-3300
Entity
Organization
Contact information
Practice address
302 N INDEPENDENCE ST, SUITE 300, ENID, OK 73701-4097
(580) 249-3915
Mailing address
PO BOX 3046, MALVERN, PA 19355-0746
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
207T00000X
Neurological Surgery Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
2084N0400X
Neurology Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208600000X
Surgery Physician
—
—
213E00000X
Podiatrist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200111620A
—
OK
01
—
DF9671
RR MEDICARE
OK
Enumeration date
04/03/2007
Last updated
06/28/2019
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