| Organization Name: | ST. MARY'S PHYSICIAN ASSOCIATES, LLC |
| NPI Number: | 1346613833 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN JOHANNESSEN (VICE PRESIDENT) |
| Mailing Address: | 1908 N 14th Street Suite 203 Ponca City |
| State: | OK US |
| Postal Code: | 746012039 |
| Phone Number: | 5802493929 |
| Fax Number: | 5802343301 |
| NPI Enumeration Date: | 11/05/2015 |
| NPI Last Update Date: | 03/29/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |