Provider Demographics
NPI:1003107897
Name:SAINTS NEUROLOGY OF ENID
Entity Type:Organization
Organization Name:SAINTS NEUROLOGY OF ENID
Other - Org Name:SAINTS MEDICAL GROUP, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:INSURANCE CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
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 269095
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9095
Mailing Address - Country:US
Mailing Address - Phone:405-272-7452
Mailing Address - Fax:405-272-7937
Practice Address - Street 1:330 S 5TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5825
Practice Address - Country:US
Practice Address - Phone:580-242-2386
Practice Address - Fax:580-233-5312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty