Provider Demographics
NPI:1356676050
Name:SAINTS MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:SAINTS MEDICAL GROUP, LLC
Other - Org Name:SAINTS WEWOKA FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLIENT ACCOUNT REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:KATY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-231-3817
Mailing Address - Street 1:PO BOX 248865
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73124-8865
Mailing Address - Country:US
Mailing Address - Phone:405-257-6272
Mailing Address - Fax:405-257-6273
Practice Address - Street 1:1509 S INDIAN RD
Practice Address - Street 2:
Practice Address - City:WEWOKA
Practice Address - State:OK
Practice Address - Zip Code:74884-9781
Practice Address - Country:US
Practice Address - Phone:405-257-6272
Practice Address - Fax:405-257-6273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2762207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty