# SAINT MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SSM HEALTH CARE OF OKLAHOMA, INC.
- **Other names:** SSM Health Medical Group Family Medicine Douglas
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1346824679
- **Legal business name:** SSM HEALTH CARE OF OKLAHOMA, INC.
- **Authorized official:** CRYSTAL L PENA (PROVIDER ENROLLMENT COORDINATOR)
- **Authorized official phone:** (405) 272-7452

## Contact information

- **Practice address:** 1212 S DOUGLAS BLVD, OKLAHOMA CITY, OK 73130-5246
- **Practice address phone:** (405) 736-6811
- **Practice address fax:** (405) 736-6863
- **Mailing address:** 1212 S DOUGLAS BLVD, OKLAHOMA CITY, OK 73130-5246
- **Mailing address phone:** (405) 736-6811
- **Mailing address fax:** (405) 736-6863

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 05/12/2021
- **Last updated:** 05/12/2021