MEDICARE: SAINTS MEDICAL GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician

General Provider Information

NPI Number	:	1336327832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINTS MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	PO BOX 248802
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73124
Country	:	US
Telephone Number	:	405-232-2178
Fax Number	:	405-272-6617

Provider Business Practice Location Address
First Line	:	608 NW 9TH ST
Second Line	:	STE 5204
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-1068
Country	:	US
Telephone Number	:	405-232-2178
Fax Number	:	405-232-6617

Authorized Official
Title or Position	:	CLIENT ACCOUNT ADMINISTRATOR
Name	:	SYNOVIA FAITH BAIN
Credential	:
Telephone Number	:	405-231-3824

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	02/06/2008

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