Healthcare Provider Details

I. General information

NPI: 1174640346
Provider Name (Legal Business Name): SAINTS MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 11/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 NW 9TH ST SUITE 4000
OKLAHOMA CITY OK
73102-1068
US

IV. Provider business mailing address

PO BOX 269082
OKLAHOMA CITY OK
73126-9082
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-6281
  • Fax: 405-231-8745
Mailing address:
  • Phone: 405-231-3857
  • Fax: 405-272-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SYNOVIA FAITH BAIN
Title or Position: CLIENT ACCOUNT ADMINISTRATOR
Credential:
Phone: 405-231-3824