Basic Information
| Provider Information | |||||||||
| NPI: | 1336767383 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHERN PLAINS MEDICAL CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2222 W IOWA AVE | ||||||||
| Address2: | |||||||||
| City: | CHICKASHA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730182738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052229573 | ||||||||
| FaxNumber: | 4052229587 | ||||||||
| Practice Location | |||||||||
| Address1: | 9 N BRYANT AVE | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730346307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052248111 | ||||||||
| FaxNumber: | 4052229587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2020 | ||||||||
| LastUpdateDate: | 07/07/2020 | ||||||||
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| AuthorizedOfficialLastName: | SILVUS | ||||||||
| AuthorizedOfficialFirstName: | EMMA | ||||||||
| AuthorizedOfficialMiddleName: | ELIZABETH | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 4052248111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SOUTHERN PLAINS MEDICAL CENTER INC | ||||||||
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| NPICertificationDate: | 07/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.