Healthcare Provider Details

I. General information

NPI: 1396034047
Provider Name (Legal Business Name): SAINTS MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NW 9TH ST STE 201
OKLAHOMA CITY OK
73106-7253
US

IV. Provider business mailing address

800 NW 9TH ST STE 201
OKLAHOMA CITY OK
73106-7253
US

V. Phone/Fax

Practice location:
  • Phone: 405-979-7875
  • Fax: 405-979-7880
Mailing address:
  • Phone: 405-979-7875
  • Fax: 405-979-7880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

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