Provider Demographics
NPI:1386823102
Name:SAINTS MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:SAINTS MEDICAL GROUP, LLC
Other - Org Name:SAINTS INTERNAL 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 268975
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8975
Mailing Address - Country:US
Mailing Address - Phone:405-272-4953
Mailing Address - Fax:405-272-4956
Practice Address - Street 1:1111 N LEE AVE
Practice Address - Street 2:SUITE 334
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2600
Practice Address - Country:US
Practice Address - Phone:405-272-4953
Practice Address - Fax:405-272-4956
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINTS MEDICAL GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-29
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200094240LMedicaid