# SAINTS MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SSM Health Medical Group Shawnee Kickapoo Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093395618
- **Authorized official:** SHASTA RENE MANUEL (VICE PRESIDENT - FINANCE)
- **Authorized official phone:** (405) 272-7282

## Contact information

- **Practice address:** 3700 N KICKAPOO AVE, SHAWNEE, OK 74804-1707
- **Practice address phone:** (405) 273-6383
- **Practice address fax:** (405) 273-3748
- **Mailing address:** 3700 N KICKAPOO AVE, SHAWNEE, OK 74804-1707
- **Mailing address phone:** (405) 273-6383
- **Mailing address fax:** (405) 273-3748

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207Y00000X | Otolaryngology Physician | — | NULL | — |
| 207Y00000X | Otolaryngology Physician | — | — | — |
| 231H00000X | Audiologist | — | NULL | — |
| 231H00000X | Audiologist | — | — | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |
| 363AM0700X | Medical Physician Assistant | — | NULL | — |
| 363AM0700X | Medical Physician Assistant | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 04/08/2021
- **Last updated:** 03/27/2024