Healthcare Provider Details

I. General information

NPI: 1689964645
Provider Name (Legal Business Name): SAINTS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 CAMERON PKWY STE 105
OKLAHOMA CITY OK
73114-3701
US

IV. Provider business mailing address

777 NW 63RD ST FL 4
OKLAHOMA CITY OK
73116-7601
US

V. Phone/Fax

Practice location:
  • Phone: 405-416-8505
  • Fax: 405-286-3136
Mailing address:
  • Phone: 405-416-8505
  • Fax: 405-286-3136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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