| NPI | 1578174983 |
|---|---|
| Doing Business As | SSM HEALTH MEDICAL GROUP AT CHESAPEAKE |
| Entity Type | Organization |
| Authorized Contact | CRYSTAL L PENA Provider Enrollment Coordinator 405-272-7452 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2021-05-07 |