Healthcare Provider Details

I. General information

NPI: 1144836206
Provider Name (Legal Business Name): SAINTS MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 08/11/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5612 S E 67TH STREET
OKLAHOMA CITY OK
73135
US

IV. Provider business mailing address

5612 SE 67TH ST
OKLAHOMA CITY OK
73135
US

V. Phone/Fax

Practice location:
  • Phone: 405-772-4750
  • Fax: 405-772-4755
Mailing address:
  • Phone: 405-772-4750
  • Fax: 405-772-4755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL L PENA
Title or Position: PROVIDER ENROLLMENT CO-ORDINATOR
Credential:
Phone: 405-272-7452