NPIMap

Organization Active NPI

St. Mary's Physician Associates, LLC

Doing business as St. Mary's Podiatry Clinic

  • Durable Medical Equipment & Medical Supplies
  • Ponca City, OK
National Provider Identifier
1346613833
Registry record updated Jun 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
ST. MARY'S PHYSICIAN ASSOCIATES, LLC
Doing business as
St. Mary's Podiatry Clinic
Practice address
1908 N 14TH Street
Suite 203
Ponca City, OK 74601-2039
Phone
(580) 249-3929
Fax
(580) 234-3301
NPI assigned
Nov 5, 2015
Last updated
Jun 28, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Todd Evans
Title
Vice President
Phone
(610) 768-3300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

1908 N 14TH Street
Suite 203
Ponca City, OK 74601-2039

Mailing address

PO Box 844737
Att: Ipm Credentialing
Dallas, TX 75284-4737
Phone (855) 298-6628

Other names 1

  • St. Mary's Podiatry Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
St Marys Physician Associates LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1446681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561680000000",
    "number": "1346613833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844737",
            "address_2": "ATT: IPM CREDENTIALING",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844737",
            "telephone_number": "855-298-6628",
            "fax_number": "903-416-1701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1908 N 14TH STREET",
            "address_2": "SUITE 203",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746012039",
            "telephone_number": "580-249-3929",
            "fax_number": "580-234-3301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY'S PHYSICIAN ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-05",
        "last_updated": "2019-06-28",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "610-768-3300"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Mary's Podiatry Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Mary's Podiatry Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ponca City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.