Provider Demographics
NPI:1164810677
Name:SAINTS MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:SAINTS MEDICAL GROUP, LLC
Other - Org Name:SSM HEALTH MEDICAL GROUP HEALTHPLEX NORTH
Other - Org Type:Doing Business As
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 1:13401 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-1408
Mailing Address - Country:US
Mailing Address - Phone:405-252-3450
Mailing Address - Fax:405-252-3499
Practice Address - Street 1:13401 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-1408
Practice Address - Country:US
Practice Address - Phone:405-252-3450
Practice Address - Fax:405-252-3499
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTH CARE OF OKLAHOMA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-06
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty