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General NPI Number Information
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NPI Number | 1811103922
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Entity Type | Organization
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Legal Business Name | SAINTS MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 02/02/2009
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Provider Practice Location Address
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Address Line | 501 N MUSTANG RD SUITE D
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City | MUSTANG
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State | OK
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Zip | 73064-7048
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Country | US
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Telephone | 405-376-0376
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Fax | 405-376-1233
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Provider Business Mailing Address
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Address Line | PO BOX 268852
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City | OKLAHOMA CITY
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State | OK
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Zip | 73126-8852
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Country | US
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Telephone | 405-376-0376
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Fax | 405-376-1233
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Authorized Official
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Title or Position | CLIENT ACCOUNT ADMINISTRATOR
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Name | SYNOVIA F BAIN
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Credential |
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Telephone | 405-231-3824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4315
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License Number State | OK
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