Shawnee Medical Center Clinic, Inc
Organization Active NPI Family Medicine Physician · Stroud, OK
NPI 1487922993 · NPPES record last updated Dec 21, 2011
Key facts
- NPI
- 1487922993
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- SHAWNEE MEDICAL CENTER CLINIC, INC
- Practice address
- 2308 W Highway 66
Suite B
Stroud, OK 74079-6729 - Phone
- (918) 968-4469
- Fax
- (918) 968-1618
- NPI assigned
- Dec 12, 2011
- Organization subpart
- No
Authorized official
- Name
- Crystal L Pena
- Title
- Insurance Credentialing Specialist
- Phone
- (405) 272-7452
Corporate family (same tax ID) 12
National Provider Directory
- Tax ID family
- Shawnee Medical Center Clinic Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
2308 W Highway 66
Suite B
Stroud, OK 74079-6729
Mailing address
PO Box 849
Shawnee, OK 74802-0849
Phone (918) 968-4469
Other names
- St Anthony Physicians-Stroud Family Medicine
Other providers in Stroud, OK
- Sac & Fox Nation
- Sac & Fox Nation
- Barry Timothy Seawright
- Margala Ann Sell
- Serenity Care LLC
- Karry L Simpson
- Camaron Eugene Snider
- Kathy Song
- Briana Lynn Spirlock
- Stroud Drug Holding LLC
All providers in Stroud, OK · Family Medicine 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 Dec 21, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.