| NPI | 1306432695 |
|---|---|
| Doing Business As | SSM HEALTH AMERICAN FIDELITY AT WORK |
| Entity Type | Organization |
| Authorized Contact | CRYSTAL L PENA Provider Enrollment Coordinator 405-272-7452 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2020-12-21 |
| Last Update Date | 2020-12-21 |