1770798134 NPI number — SAINTS MEDICAL GROUP, LLC

Table of content: (NPI 1770798134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770798134 NPI number — SAINTS MEDICAL GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINTS MEDICAL GROUP, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BRAD A MARION, MD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770798134
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1110 N CLASSEN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73106-6843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-272-7452
Provider Business Mailing Address Fax Number:
405-272-7937

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
608 NW 9TH ST
Provider Second Line Business Practice Location Address:
SUITE 3110
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73102-1068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-272-8338
Provider Business Practice Location Address Fax Number:
405-272-6030
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PENA
Authorized Official First Name:
CRYSTAL
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
405-272-7452

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200094240U , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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