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Organization
SAINT MEDICAL GROUP, LLC
Active
Organization
SAINT MEDICAL GROUP, LLC
Active
Parent organization
SSM HEALTHCARE OF OK, INC
Other names
SSM Health Healthy Living OKC Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
SSM HEALTHCARE OF OK, INC
Authorized official
CRYSTAL L PENA (PROVIDER ENROLLMENT COORDINATOR)
(405) 272-7452
Entity
Organization
Contact information
Practice address
11501 N ROCKWELL AVE, OKLAHOMA CITY, OK 73162-2732
(405) 578-3380
(405) 578-3382
Mailing address
11501 N ROCKWELL AVE, OKLAHOMA CITY, OK 73162-2732
(405) 578-3380
(405) 578-3382
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
363L00000X
Nurse Practitioner
Primary
—
NULL
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
04/30/2021
Last updated
04/30/2021
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