Provider Demographics
NPI:1639612518
Name:ST ANTHONY PHYSICIANS ALLERGY
Entity Type:Organization
Organization Name:ST ANTHONY PHYSICIANS ALLERGY
Other - Org Name:SAINTS MEDICAL GROUP, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE 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 1:6205 N SANTA FE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-7537
Mailing Address - Country:US
Mailing Address - Phone:405-772-4390
Mailing Address - Fax:405-772-4399
Practice Address - Street 1:6205 N SANTA FE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-7537
Practice Address - Country:US
Practice Address - Phone:405-772-4390
Practice Address - Fax:405-772-4399
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTH CARE OF OKLAHOMA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty