Provider Demographics
NPI:1306977749
Name:SSM HEALTH CARE OF OKLAHOMA INC
Entity type:Organization
Organization Name:SSM HEALTH CARE OF OKLAHOMA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLIENT ACCOUNT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SYNOVIA
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:BAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-231-3824
Mailing Address - Street 1:PO BOX 269007
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9007
Mailing Address - Country:US
Mailing Address - Phone:405-231-3857
Mailing Address - Fax:405-942-7743
Practice Address - Street 1:1000 N LEE AVE
Practice Address - Street 2:SUITE 1921
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1036
Practice Address - Country:US
Practice Address - Phone:405-272-6053
Practice Address - Fax:405-272-6928
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTH CARE OF OKLAHOMA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-08
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty