Shawnee Medical Center Clinic, Inc
Organization Active NPI Orthopaedic Surgery Physician · Shawnee, OK
NPI 1104462167 · NPPES record last updated Nov 25, 2019
Key facts
- NPI
- 1104462167
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- Legal business name
- SHAWNEE MEDICAL CENTER CLINIC, INC
- Practice address
- 3315 Kethley Rd
Shawnee, OK 74804-9638 - Phone
- (405) 273-5801
- Fax
- (405) 878-3794
- NPI assigned
- Nov 25, 2019
- Organization subpart
- Yes
- Parent organization (as reported)
- SSM HEALTH CARE OF OKLAHOMA, INC.
Authorized official
- Name
- Crystal L Pena
- Title
- Credentialing Specialist
- Phone
- (405) 272-7452
Corporate family (same tax ID) 12
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 37D0697941 | SSM Health Medical Group | Accreditation | Aug 11, 2027 |
National Provider Directory
- Tax ID family
- Shawnee Medical Center Clinic Inc
- Part of
- Marilyn Doughtery MD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician |
207X00000X | Yes | ||
| Durable Medical Equipment & Medical Supplies | 332B00000X |
Addresses
Primary practice location
3315 Kethley Rd
Shawnee, OK 74804-9638
Mailing address
3315 Kethley Rd
Shawnee, OK 74804-9638
Phone (405) 273-5801
Other names
- SSM Health Medical Group Shawnee Ortho
Other providers in Shawnee, OK
- Shawnee Dental, PLLC
- Shawnee Dentistry and Braces
- Shawnee Discount Drug
- Shawnee Eye Associates, PLLC
- Shawnee Heart Center Inc
- Shawnee Medical Center Clinic, Inc
- Shawnee Medical Center Clinic, Inc
- Shawnee MRI Associates, L.L.C.
- Shawnee Pedorthic Service, Inc.
- Shawnee Physical Therapy PC
All providers in Shawnee, OK · Orthopaedic Surgery Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 25, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.