Shawnee Medical Center Clinic, INC

NPI #1104462167 in Shawnee, Oklahoma

Provider Information

NPI Number
1104462167
Entity Type
Organization
Organization Name
Shawnee Medical Center Clinic, INC
Subpart
Yes (part of a larger organization)
Parent Organization
SSM HEALTH CARE OF OKLAHOMA, INC.
Primary Specialty
Orthopaedic Surgery
Enumeration Date
Nov 25, 2019
Last Updated
Nov 25, 2019

Practice Location

Address
3315 KETHLEY RD
ZIP Code
74804-9638
Phone
(405) 273-5801

Authorized Official

Name
CRYSTAL L PENA
Title
CREDENTIALING SPECIALIST
Phone
(405) 272-7452

Specialties & Taxonomy Codes

Specialty
Durable Medical Equipment & Medical Supplies
Orthopaedic Surgery

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