1992995344 NPI number — SAINTS MEDICAL GROUP, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992995344 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:
CENTER FOR INTEGRATIVE WOMENS HEALTH
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:
1992995344
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 268986
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:
73126-8986
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-231-3857
Provider Business Mailing Address Fax Number:
405-272-7977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 NW 9TH ST
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73102-1070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-272-8498
Provider Business Practice Location Address Fax Number:
405-272-8425
Provider Enumeration Date:
07/31/2007

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

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




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