Healthcare Provider Details

I. General information

NPI: 1013506997
Provider Name (Legal Business Name): SAINT MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 NW 56TH ST
OKLAHOMA CITY OK
73112-4463
US

IV. Provider business mailing address

3400 NW 56TH ST
OKLAHOMA CITY OK
73112-4463
US

V. Phone/Fax

Practice location:
  • Phone: 405-946-5563
  • Fax: 405-947-6226
Mailing address:
  • Phone: 405-946-5563
  • Fax: 405-947-6226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number State

VIII. Authorized Official

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