Healthcare Provider Details

I. General information

NPI: 1285884676
Provider Name (Legal Business Name): SAINTS MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 NW 9TH ST SUITE 3206
OKLAHOMA CITY OK
73102-1068
US

IV. Provider business mailing address

PO BOX 248829
OKLAHOMA CITY OK
73124-8829
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-7044
  • Fax: 405-272-7049
Mailing address:
  • Phone: 405-272-7044
  • Fax: 405-272-7049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number22879
License Number StateOK

VIII. Authorized Official

Name: KATY S BAIN
Title or Position: CLIENT ACCOUNT REPRESENTATIVE
Credential:
Phone: 405-231-3817