Healthcare Provider Details

I. General information

NPI: 1336235159
Provider Name (Legal Business Name): SAINTS MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N LEE AVE
OKLAHOMA CITY OK
73102-1036
US

IV. Provider business mailing address

PO BOX 269009
OKLAHOMA CITY OK
73126-9009
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-6216
  • Fax: 405-272-6927
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

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