Healthcare Provider Details

I. General information

NPI: 1508212572
Provider Name (Legal Business Name): SAINT MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 09/02/2025
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3204 MEDICAL PARK DR
SHAWNEE OK
74804-5014
US

IV. Provider business mailing address

PO BOX 958210
SAINT LOUIS MO
63195-8210
US

V. Phone/Fax

Practice location:
  • Phone: 405-878-6800
  • Fax: 405-878-3794
Mailing address:
  • Phone: 405-231-3857
  • Fax: 405-272-7977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SHASTA R MANUEL
Title or Position: VICE PRESIDENT - FINANCE
Credential:
Phone: 405-272-7282