NPIMap

Saint Medical Group, LLC

Organization Active NPI Orthopaedic Surgery Physician · Mustang, OK

NPI 1669018057 · NPPES record last updated Nov 21, 2019

Key facts

NPI
1669018057
Entity type
Organization (NPI type 2)
Primary specialty
Orthopaedic Surgery Physician 207X00000X
Legal business name
SAINT MEDICAL GROUP, LLC
Practice address
201 S Sara Rd Ste 201
Mustang, OK 73064-4306
Phone
(405) 578-3250
Fax
(405) 578-3299
NPI assigned
Nov 21, 2019
Organization subpart
Yes
Parent organization (as reported)
SSM HEALTH CARE OF OKLAHOMA, INC.

Authorized official

Name
Crystal L Pena
Title
Credentialing Specialist
Phone
(405) 272-7452

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Tax ID family
Saints Neurology of Enid (114 organizations share this tax ID)
Part of
Marilyn Doughtery MD

Locations

201 S Sara Rd
Ste 201
Mustang, OK 73064
Phone (405) 578-3250

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207X00000X Yes
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

201 S Sara Rd Ste 201
Mustang, OK 73064-4306

Mailing address

201 S Sara Rd Ste 201
Mustang, OK 73064-4306
Phone (405) 578-3250

Other names

  • SSM Health Medical Group Ortho Mustang Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 21, 2019.

{
    "created_epoch": "1574294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574294400000",
    "number": "1669018057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 S SARA RD STE 201",
            "city": "MUSTANG",
            "state": "OK",
            "postal_code": "730644306",
            "telephone_number": "405-578-3250",
            "fax_number": "405-578-3299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S SARA RD STE 201",
            "city": "MUSTANG",
            "state": "OK",
            "postal_code": "730644306",
            "telephone_number": "405-578-3250",
            "fax_number": "405-578-3299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SSM HEALTH CARE OF OKLAHOMA, INC.",
        "enumeration_date": "2019-11-21",
        "last_updated": "2019-11-21",
        "status": "A",
        "authorized_official_last_name": "PENA",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "405-272-7452"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Medical Group Ortho Mustang",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mustang, OK

All providers in Mustang, OK · Orthopaedic Surgery Physician in Oklahoma

Sources for this page

Verify at the official NPI Registry.