Provider Demographics
NPI:1679588552
Name:STILLWATER MEDICAL CENTER AUTHORITY
Entity type:Organization
Organization Name:STILLWATER MEDICAL CENTER AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENDREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-742-5729
Mailing Address - Street 1:1323 W 6TH AVE
Mailing Address - Street 2:BOX 2408
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4306
Mailing Address - Country:US
Mailing Address - Phone:405-533-2667
Mailing Address - Fax:405-742-4990
Practice Address - Street 1:1301 W 6TH AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4375
Practice Address - Country:US
Practice Address - Phone:405-533-2667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK41122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty