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NPI Code Detail

MEDICARE: SAINTS MEDICAL GROUP LLC

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
1207N00000XDermatology Physician26344OK

General Provider Information

NPI Number : 1770845729
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAINTS MEDICAL GROUP LLC
Provider Business Mailing Address
First Line : 13128 N MACARTHUR BLVD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73142-3017
Country : US
Telephone Number : 405-272-7044
Fax Number : 405-272-7049
Provider Business Practice Location Address
First Line : 13128 N MACARTHUR BLVD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73142-3017
Country : US
Telephone Number : 405-272-7044
Fax Number : 405-272-7049
Authorized Official
Title or Position : INSURANCE CREDENTIALING SPECIALIST
Name : CRYSTAL L PENA
Credential :
Telephone Number : 405-272-7452
Provider Enumeration Date : 06/14/2012
Last Update Date : 06/14/2012

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Directions to “SAINTS MEDICAL GROUP LLC ” Practice Location

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