Organization
SHAWNEE MEDICAL CENTER CLINIC, INC
Active
Parent organization
SSM HEALTH CARE OF OKLAHOMA, INC
Other names
SSM Health Specialty Clinic Ada
Organization subpart
Yes
Provider details
NPI number
Legal business name
SSM HEALTH CARE OF OKLAHOMA, INC
Authorized official
CRYSTAL L PENA (PROVIDER ENROLLMENT/INS CREDENTIAL)
(405) 272-7452
Entity
Organization
Contact information
Practice address
3012 ARLINGTON ST, ADA, OK 74820-3073
(580) 272-0715
(580) 272-0772
Mailing address
3012 ARLINGTON ST, ADA, OK 74820-3073
(580) 272-0715
(580) 272-0772
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RG0100X
Gastroenterology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207RR0500X
Rheumatology Physician
—
—
Other
Enumeration date
10/11/2019
Last updated
10/11/2019
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