Healthcare Provider Details

I. General information

NPI: 1194298117
Provider Name (Legal Business Name): SAINTS MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N W 9TH STREET SUITE 100
OKLAHOMA CITY OK
73106-0000
US

IV. Provider business mailing address

800 N W 9TH STREET SUITE 100
OKLAHOMA CITY OK
73106-7248
US

V. Phone/Fax

Practice location:
  • Phone: 405-815-5050
  • Fax: 405-815-5051
Mailing address:
  • Phone: 405-815-5050
  • Fax: 405-815-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

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