Provider Demographics
NPI:1093013948
Name:SAINTS MEDICAL GROUP
Entity Type:Organization
Organization Name:SAINTS MEDICAL GROUP
Other - Org Name:SAINTS DERMATOLOGY ENID
Other - Org Type:Doing Business As
Authorized Official - Title/Position: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 1:330 S 5TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5825
Mailing Address - Country:US
Mailing Address - Phone:580-242-2386
Mailing Address - Fax:580-233-5312
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?:Yes
Parent Organization LBN:SSM HEALTHCARE OF OK, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-02
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty