Healthcare Provider Details

I. General information

NPI: 1356803308
Provider Name (Legal Business Name): SAINT MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 PARKVIEW DR STE 2A
EL RENO OK
73036-2149
US

IV. Provider business mailing address

2315 PARKVIEW DR STE 2A
EL RENO OK
73036-2149
US

V. Phone/Fax

Practice location:
  • Phone: 405-252-3550
  • Fax: 405-252-3555
Mailing address:
  • Phone: 405-252-3550
  • Fax: 405-252-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL L PENA
Title or Position: INSURANCE CREDENTIALING SPECIALIST
Credential:
Phone: 405-272-7452