Provider Demographics
NPI:1225674617
Name:SAINT MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:SAINT MEDICAL GROUP, LLC
Other - Org Name:SSM HEALTH BONE & JOINT OSOI EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position: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 1:3400 S DOUGLAS BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73150-1018
Mailing Address - Country:US
Mailing Address - Phone:405-272-2850
Mailing Address - Fax:405-272-2898
Practice Address - Street 1:3400 S DOUGLAS BLVD STE 302
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73150-1018
Practice Address - Country:US
Practice Address - Phone:405-272-2850
Practice Address - Fax:405-272-2898
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTH CARE OF OKLAHOMA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty