Provider Demographics
NPI:1689964645
Name:SAINTS MEDICAL GROUP
Entity Type:Organization
Organization Name:SAINTS MEDICAL GROUP
Other - Org Name:SAINTS ON SITE AT AMERICAN FIDELITY
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 1:777 NW 63RD ST FL 4
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7601
Mailing Address - Country:US
Mailing Address - Phone:405-416-8505
Mailing Address - Fax:405-286-3136
Practice Address - Street 1:9000 CAMERON PKWY STE 105
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-3701
Practice Address - Country:US
Practice Address - Phone:405-416-8505
Practice Address - Fax:405-286-3136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty