| NPI | 1093395618 |
|---|---|
| Doing Business As | SSM HEALTH MEDICAL GROUP SHAWNEE KICKAPOO CLINIC |
| Entity Type | Organization |
| Authorized Contact | SHASTA RENE MANUEL Vice President Finance 405-272-7282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207Y00000X Otolaryngology | |
| 231H00000X Audiologist | |
| 363AM0700X Physician Assistant, Medical | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2024-03-27 |