Healthcare Provider Details

I. General information

NPI: 1720664071
Provider Name (Legal Business Name): SAINT MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9060 HARMONY DR
MIDWEST CITY OK
73130-6218
US

IV. Provider business mailing address

9060 HARMONY DR
MIDWEST CITY OK
73130-6218
US

V. Phone/Fax

Practice location:
  • Phone: 405-610-8090
  • Fax:
Mailing address:
  • Phone: 405-610-8090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL L PENA
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 405-272-7452