Healthcare Provider Details

I. General information

NPI: 1710160866
Provider Name (Legal Business Name): SAINTS MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 NW 58TH ST
OKLAHOMA CITY OK
73118-5915
US

IV. Provider business mailing address

PO BOX 268990
OKLAHOMA CITY OK
73126-8990
US

V. Phone/Fax

Practice location:
  • Phone: 405-218-2500
  • Fax: 405-218-2560
Mailing address:
  • Phone: 405-218-2500
  • Fax: 405-218-2560

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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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