Saint Medical Group, LLC
Nurse Practitioner in Oklahoma City, OK. Organization (NPI-2).
NPI number1699358317
StatusActive
Last updated in NPPESApr 30, 2021
Details
- NPI
- 1699358317
- Entity type
- Organization (NPI-2)
- Legal business name
- Saint Medical Group, LLC
- Organization subpart
- Yes
- Enumeration date
- Apr 30, 2021
- Certification date
- Apr 5, 2021
- Last updated
- Apr 30, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363L00000X | Nurse Practitioner | – | – | Yes |
| 207Q00000X | Family Medicine | – | – | |
| 207R00000X | Internal Medicine | – | – |
Other names
- Ssm Health Healthy Living Okc Clinic (Doing Business As)
Practice location
11501 N Rockwell AveOklahoma City, OK 73162-2732
Phone 405-578-3380 · Fax 405-578-3382
Mailing address
11501 N Rockwell AveOklahoma City, OK 73162-2732
Phone 405-578-3380 · Fax 405-578-3382
Authorized official
Crystal L Pena
Provider Enrollment Coordinator
4052727452
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