Organization
SAINT MEDICAL GROUP, LLC
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
Legal business name
SSM HEALTH CARE OF OKLAHOMA, INC.
Authorized official
CRYSTAL L PENA (PROVIDER ENROLLMENT COORDINATOR)
(405) 272-7452
Entity
Organization
Contact information
Practice address
1212 S DOUGLAS BLVD, OKLAHOMA CITY, OK 73130-5246
(405) 736-6811
(405) 736-6863
Mailing address
1212 S DOUGLAS BLVD, OKLAHOMA CITY, OK 73130-5246
(405) 736-6811
(405) 736-6863
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
05/12/2021
Last updated
05/12/2021
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