| NPI | 1487677456 |
|---|---|
| Doing Business As | SSM HEALTH MEDICAL GROUP FAMILY MEDICINE CLINIC |
| Entity Type | Organization |
| Authorized Contact | CRYSTAL L PENA Senior Provider Enrollment 405-272-7452 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 103T00000X Psychologist |
| 207LP2900X Anesthesiology, Pain Medicine | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2023-08-23 |