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DSH370037U SSM ST ANTHONY HOSPITAL (Terminated)
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Main Details
Name
SSM ST ANTHONY HOSPITAL
Subdivision Name
St. Anthony Shawnee Physicians Shawnee Family Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH370037U
Medicare Provider Number
370037
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2014
Participating Start Date
7/1/2014
Participating Approval Date
5/29/2014
Last Recertification Date
8/7/2014
Termination Date
Termination Reason
7/1/2015
Site closure
Contacts
Authorizing Official
- SSM ST ANTHONY HOSPITAL
Shasta Manuel, VP of Finance CFO
(405) 272-7282
Primary Contact
Shasta Manuel, System Vice President/CFO
(405) 272-7282
Addresses
Street Address
3214 Kethley Road
Shawnee, OK 74804
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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