Healthcare Provider Details

I. General information

NPI: 1699948646
Provider Name (Legal Business Name): SAINTS MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 NW 23RD ST
BETHANY OK
73008-5159
US

IV. Provider business mailing address

PO BOX 248804
OKLAHOMA CITY OK
73124-8804
US

V. Phone/Fax

Practice location:
  • Phone: 405-789-1130
  • Fax: 405-789-1132
Mailing address:
  • Phone: 405-231-3857
  • Fax: 405-942-7743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SYNOVIA FAITH BAIN
Title or Position: CLIENT ACCOUNT ADMINISTRATOR
Credential:
Phone: 405-231-3824