Provider Demographics
NPI:1912739020
Name:ST. ANTHONY SHAWNEE HOSPITAL, INC.
Entity type:Organization
Organization Name:ST. ANTHONY SHAWNEE HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:KEG VP FINANCE-OKLAHOMA/MM
Authorized Official - Prefix:
Authorized Official - First Name:SHASTA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-272-7282
Mailing Address - Street 1:3210 KETHLEY RD.
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-9625
Mailing Address - Country:US
Mailing Address - Phone:405-273-9417
Mailing Address - Fax:405-273-8849
Practice Address - Street 1:3210 KETHLEY RD.
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-9625
Practice Address - Country:US
Practice Address - Phone:405-273-9417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200697170BMedicaid