Healthcare Provider Details

I. General information

NPI: 1184859464
Provider Name (Legal Business Name): SAINTS MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 NW 9TH ST SUITE 205
OKLAHOMA CITY OK
73102-1070
US

IV. Provider business mailing address

PO BOX 269064
OKLAHOMA CITY OK
73126-9064
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-4953
  • Fax: 405-272-4905
Mailing address:
  • Phone: 405-272-4953
  • Fax: 405-272-4905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number23917
License Number StateOK

VIII. Authorized Official

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