Basic Information
| Provider Information | |||||||||
| NPI: | 1396116745 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHAWNEE MEDICAL CENTER CLINIC, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ST. ANTHONY PHYSICIANS CHANDLER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 849 | ||||||||
| Address2: | |||||||||
| City: | SHAWNEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748020849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052582500 | ||||||||
| FaxNumber: | 4052583053 | ||||||||
| Practice Location | |||||||||
| Address1: | 114 N HIGHWAY 18 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748341200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052582500 | ||||||||
| FaxNumber: | 4052583053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2015 | ||||||||
| LastUpdateDate: | 10/12/2015 | ||||||||
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| AuthorizedOfficialLastName: | ADAMS | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ACCOUNTANT/CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 4053953931 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.