Healthcare Provider Details

I. General information

NPI: 1871058362
Provider Name (Legal Business Name): SAINT MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 NW 56TH ST
OKLAHOMA CITY OK
73112-4550
US

IV. Provider business mailing address

3525 NW 56TH ST
OKLAHOMA CITY OK
73112-4550
US

V. Phone/Fax

Practice location:
  • Phone: 405-917-3434
  • Fax: 405-917-3430
Mailing address:
  • Phone: 405-917-3434
  • Fax: 405-917-3430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

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