Provider Demographics
NPI:1659528222
Name:SAINTS MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:SAINTS MEDICAL GROUP, LLC
Other - Org Name:YOURCARE CLINIC - SOUTH PENN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLIENT ACCOUNT REP
Authorized Official - Prefix:
Authorized Official - First Name:KATY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-231-3817
Mailing Address - Street 1:PO BOX 248804
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73124-8804
Mailing Address - Country:US
Mailing Address - Phone:405-378-7600
Mailing Address - Fax:405-378-7603
Practice Address - Street 1:10700 S PENN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-4206
Practice Address - Country:US
Practice Address - Phone:405-378-7600
Practice Address - Fax:405-378-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty