Provider Demographics
NPI:1275724825
Name:SAINTS MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:SAINTS MEDICAL GROUP, LLC
Other - Org Name:SAINTS FAMILY HEALTH CENTER MIDWEST CITY
Other - Org Type:Other Name
Authorized Official - Title/Position:CLIENT ACCOUNT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SYNOVIA
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:BAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-231-3824
Mailing Address - Street 1:PO BOX 268960
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8960
Mailing Address - Country:US
Mailing Address - Phone:405-231-3857
Mailing Address - Fax:405-942-7743
Practice Address - Street 1:9020 E RENO AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-3336
Practice Address - Country:US
Practice Address - Phone:405-732-0397
Practice Address - Fax:405-737-5901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINTS MEDICAL GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-08
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200094240GMedicaid