Healthcare Provider Details

I. General information

NPI: 1508263229
Provider Name (Legal Business Name): SAINTS MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S SARA ROAD SUITE 200
MUSTANG OK
73064-4562
US

IV. Provider business mailing address

201 S SARA ROAD SUITE 200
MUSTANG OK
73064-4562
US

V. Phone/Fax

Practice location:
  • Phone: 405-578-3250
  • Fax: 405-578-3299
Mailing address:
  • Phone: 405-578-3250
  • Fax: 405-578-3299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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