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Shawnee Medical Center Clinic, Inc.

Organization Active NPI Family Medicine Physician · Seminole, OK

NPI 1861034779 · NPPES record last updated Oct 11, 2019

Key facts

NPI
1861034779
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
SHAWNEE MEDICAL CENTER CLINIC, INC.
Practice address
2403 W Wrangler Blvd Ste C
Seminole, OK 74868-1900
Phone
(405) 716-3070
Fax
(405) 716-3069
NPI assigned
Oct 11, 2019
Organization subpart
Yes
Parent organization (as reported)
SSM HEALTH CARE OF OKLAHOMA, INC

Authorized official

Name
Crystal L Pena
Title
Provider Enrollment/Ins Credential
Phone
(405) 272-7452

Corporate family (same tax ID) 12

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

National Provider Directory

Tax ID family
Shawnee Medical Center Clinic Inc (13 organizations share this tax ID)
Part of
Marilyn Doughtery MD

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes
Physician Assistant
Group: 193200000X MULTI-SPECIALTY GROUP		 363A00000X
Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363L00000X

Addresses

Primary practice location

2403 W Wrangler Blvd Ste C
Seminole, OK 74868-1900

Mailing address

2403 W Wrangler Blvd Ste C
Seminole, OK 74868-1900
Phone (405) 716-3070

Other names

  • SSM Health Medical Group Seminole Doing business as

Other providers in Seminole, OK

All providers in Seminole, OK · Family Medicine Physician in Oklahoma

Sources for this page

Verify at the official NPI Registry.