| NPI | 1013506997 |
|---|---|
| Doing Business As | SSM HEALTH MEDICAL GROUP OTOLOGY |
| Entity Type | Organization |
| Authorized Contact | CRYSTAL L PENA Provider Enrollment Coordinator 405-272-7452 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207YX0901X Otolaryngology, Otology & Neurotology |
| Additional Taxonomies | 231H00000X Audiologist |
| Enumeration Date | 2021-01-14 |
| Last Update Date | 2021-01-14 |