Healthcare Provider Details

I. General information

NPI: 1902186984
Provider Name (Legal Business Name): SAINTS MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 08/23/2011
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

1111 N LEE AVE SUITE 334
OKLAHOMA CITY OK
73103-2600
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 Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

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