Healthcare Provider Details

I. General information

NPI: 1275737397
Provider Name (Legal Business Name): SAINTS MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 NW 9TH ST 3000
OKLAHOMA CITY OK
73102-1068
US

IV. Provider business mailing address

PO BOX 268851
OKLAHOMA CITY OK
73126-8851
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-7337
  • Fax: 405-231-3059
Mailing address:
  • Phone: 405-272-7337
  • Fax: 405-231-3059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

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