Healthcare Provider Details

I. General information

NPI: 1770798134
Provider Name (Legal Business Name): SAINTS MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 NW 9TH ST SUITE 3110
OKLAHOMA CITY OK
73102-1068
US

IV. Provider business mailing address

1110 N CLASSEN BLVD
OKLAHOMA CITY OK
73106-6843
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-8338
  • Fax: 405-272-6030
Mailing address:
  • Phone: 405-272-7452
  • Fax: 405-272-7937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

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