MEDICARE: SAINT MEDICAL GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1306432695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	2000 N CLASSEN BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-6016
Country	:	US
Telephone Number	:	405-523-5034
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 N CLASSEN BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-6016
Country	:	US
Telephone Number	:	405-523-5034
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER ENROLLMENT COORDINATOR
Name	:	CRYSTAL L PENA
Credential	:
Telephone Number	:	405-272-7452

Provider Enumeration Date	:	12/21/2020
Last Update Date	:	12/21/2020

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Directions to “SAINT MEDICAL GROUP, LLC ” Practice Location

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