Healthcare Provider Details

I. General information

NPI: 1053446120
Provider Name (Legal Business Name): SAINTS MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N LEE AVE SUITE 334
OKLAHOMA CITY OK
73103-2600
US

IV. Provider business mailing address

PO BOX 268972
OKLAHOMA CITY OK
73126-8972
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-4953
  • Fax: 405-272-4956
Mailing address:
  • Phone: 405-272-4953
  • Fax: 405-272-4956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number27645
License Number StateOK

VIII. Authorized Official

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