Organization
SHAWNEE MEDICAL CENTER CLINIC, INC.
Active
Parent organization
SSM HEALTH CARE OF OKLAHOMA, INC
Other names
SSM Health Medical Group Seminole
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
2403 W WRANGLER BLVD STE C, SEMINOLE, OK 74868-1900
(405) 716-3070
(405) 716-3069
Mailing address
2403 W WRANGLER BLVD STE C, SEMINOLE, OK 74868-1900
(405) 716-3070
(405) 716-3069
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
10/11/2019
Last updated
10/11/2019
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