Provider Demographics
NPI:1295363620
Name:SAINT MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:SAINT MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT 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 307
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73150-1001
Mailing Address - Country:US
Mailing Address - Phone:405-218-2582
Mailing Address - Fax:405-218-2587
Practice Address - Street 1:3400 S DOUGLAS BLVD STE 307
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73150-1001
Practice Address - Country:US
Practice Address - Phone:405-218-2582
Practice Address - Fax:405-218-2587
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTHCARE OF OK, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty