| Shawnee Medical Center Clinic, Inc | |
|
3315 Kethley Rd Shawnee OK 74804-9638 | |
| (405) 273-5801 | |
| (405) 878-3794 |
| Full Name | Shawnee Medical Center Clinic, Inc |
|---|---|
| Speciality | Social Worker |
| Location | 3315 Kethley Rd, Shawnee, Oklahoma |
| Authorized Official Name and Position | Crystal L Pena (INSURANCE CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 4052727452 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shawnee Medical Center Clinic, Inc 3315 Kethley Rd Shawnee OK 74804-9638 Ph: (405) 273-5801 | Shawnee Medical Center Clinic, Inc 3315 Kethley Rd Shawnee OK 74804-9638 Ph: (405) 273-5801 |
| NPI Number | 1205301231 |
|---|---|
| Provider Enumeration Date | 10/05/2018 |
| Last Update Date | 10/05/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205301231 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
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