NPIMap

Organization Active NPI

Shawnee Medical Center Clinic, Inc

Doing business as St Anthony Physicians-Stroud Family Medicine

  • Family Medicine Physician
  • Stroud, OK
National Provider Identifier
1487922993
Registry record updated Dec 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SHAWNEE MEDICAL CENTER CLINIC, INC
Doing business as
St Anthony Physicians-Stroud Family Medicine
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
Last updated
Dec 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2011

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

Authorized official

Name
Crystal L Pena
Title
Insurance Credentialing Specialist
Phone
(405) 272-7452

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

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 1

  • St Anthony Physicians-Stroud Family Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Shawnee Medical Center Clinic Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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": "1323648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324425600000",
    "number": "1487922993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 849",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748020849",
            "telephone_number": "918-968-4469",
            "fax_number": "918-968-1618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2308 W HIGHWAY 66",
            "address_2": "SUITE B",
            "city": "STROUD",
            "state": "OK",
            "postal_code": "740796729",
            "telephone_number": "918-968-4469",
            "fax_number": "918-968-1618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAWNEE MEDICAL CENTER CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-12",
        "last_updated": "2011-12-21",
        "status": "A",
        "authorized_official_last_name": "PENA",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "INSURANCE CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "405-272-7452"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Anthony Physicians-Stroud Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stroud, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2011; 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.