Provider Demographics
NPI:1124296538
Name:SAINTS MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:SAINTS MEDICAL GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-272-7452
Mailing Address - Street 1:PO BOX 268986
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8986
Mailing Address - Country:US
Mailing Address - Phone:405-272-5555
Mailing Address - Fax:405-272-5517
Practice Address - Street 1:6201 N SANTA FE AVE
Practice Address - Street 2:2010
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-7538
Practice Address - Country:US
Practice Address - Phone:405-272-5555
Practice Address - Fax:405-272-5517
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTHCARE OF OKLAHOMA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-19
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100522016OtherMEDICARE ID