Healthcare Provider Details

I. General information

NPI: 1578159729
Provider Name (Legal Business Name): SAINT MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2129 SW 59TH ST
OKLAHOMA CITY OK
73119-7024
US

IV. Provider business mailing address

2129 SW 59TH ST
OKLAHOMA CITY OK
73119-7024
US

V. Phone/Fax

Practice location:
  • Phone: 405-713-5960
  • Fax: 405-713-5963
Mailing address:
  • Phone: 405-713-5960
  • Fax: 405-713-5963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

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