Healthcare Provider Details

I. General information

NPI: 1851971550
Provider Name (Legal Business Name): SAINT MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 RONNIES PLZ
SAPPINGTON MO
63126-3552
US

IV. Provider business mailing address

30 RONNIES PLZ
SAPPINGTON MO
63126-3552
US

V. Phone/Fax

Practice location:
  • Phone: 314-989-6807
  • Fax: 314-989-6608
Mailing address:
  • Phone: 314-989-6807
  • Fax: 314-989-6608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL L PENA
Title or Position: PROVIDER COORDINATOR
Credential:
Phone: 405-272-7452