Healthcare Provider Details

I. General information

NPI: 1366644577
Provider Name (Legal Business Name): SAINTS MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 SW 23RD ST SUITE 101
OKLAHOMA CITY OK
73108
US

IV. Provider business mailing address

PO BOX 268960
OKLAHOMA CITY OK
73126-8960
US

V. Phone/Fax

Practice location:
  • Phone: 405-948-6300
  • Fax: 405-948-6301
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 Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

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