MEDICARE: SAINTS 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician

General Provider Information

NPI Number	:	1659844587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINTS MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	6205 N SANTA FE AVE STE 200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7536
Country	:	US
Telephone Number	:	405-231-8740
Fax Number	:	405-231-8714

Provider Business Practice Location Address
First Line	:	6205 N SANTA FE AVE STE 200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7536
Country	:	US
Telephone Number	:	405-231-8740
Fax Number	:	405-231-8714

Authorized Official
Title or Position	:	INSURANCE CREDENTIALING SPECIALIST
Name	:	CRYSTAL L PENA
Credential	:
Telephone Number	:	405-272-7452

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	01/03/2019

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