Healthcare Provider Details

I. General information

NPI: 1093013948
Provider Name (Legal Business Name): SAINTS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S 5TH ST SUITE 400
ENID OK
73701-5825
US

IV. Provider business mailing address

330 S 5TH ST SUITE 400
ENID OK
73701-5825
US

V. Phone/Fax

Practice location:
  • Phone: 580-242-2386
  • Fax: 580-233-5312
Mailing address:
  • Phone: 580-242-2386
  • Fax: 580-233-5312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

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