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	207RI0011X	Interventional Cardiology Physician	20073	OK

General Provider Information

NPI Number	:	1760716518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINTS MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	PO BOX 248863
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73124-8863
Country	:	US
Telephone Number	:	580-272-0715
Fax Number	:	580-272-0771

Provider Business Practice Location Address
First Line	:	3012 ARLINGTON ST
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-3073
Country	:	US
Telephone Number	:	580-272-0715
Fax Number	:	580-272-0771

Authorized Official
Title or Position	:	CLIENT ACCOUNT REPRESENTATIVE
Name	:	KATY BAIN
Credential	:
Telephone Number	:	405-231-3817

Provider Enumeration Date	:	09/28/2009
Last Update Date	:	09/28/2009

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