| NPI | 1598225369 |
|---|---|
| Doing Business As | SSM HEALTH MEDICAL GROUP PAULS VALLEY |
| Entity Type | Organization |
| Authorized Contact | CRYSTAL L PENA Provider Enrollment 405-272-7452 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2019-03-20 |