Healthcare Provider Details

I. General information

NPI: 1487290771
Provider Name (Legal Business Name): SAINTS MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13401 N WESTERN AVE STE 301
OKLAHOMA CITY OK
73114-1411
US

IV. Provider business mailing address

13401 N WESTERN AVE STE 301
OKLAHOMA CITY OK
73114-1411
US

V. Phone/Fax

Practice location:
  • Phone: 405-218-2530
  • Fax: 405-578-3299
Mailing address:
  • Phone: 405-218-2530
  • Fax: 405-578-3299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHASTA RENE MANUEL
Title or Position: VP - FINANCE
Credential:
Phone: 405-272-7282