Healthcare Provider Details

I. General information

NPI: 1548761513
Provider Name (Legal Business Name): SAINT MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 NW 9TH ST STE 5000
OKLAHOMA CITY OK
73102-1018
US

IV. Provider business mailing address

608 NW 9TH ST STE 5000
OKLAHOMA CITY OK
73102-1018
US

V. Phone/Fax

Practice location:
  • Phone: 405-772-4533
  • Fax: 405-772-4539
Mailing address:
  • Phone: 405-772-4533
  • Fax: 405-772-4539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateOK

VIII. Authorized Official

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