Basic Information
| Provider Information | |||||||||
| NPI: | 1003107897 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAINTS NEUROLOGY OF ENID | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SAINTS MEDICAL GROUP, LLC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 269095 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731269095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052727452 | ||||||||
| FaxNumber: | 4052727937 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 S 5TH ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | ENID | ||||||||
| State: | OK | ||||||||
| PostalCode: | 737015825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802422386 | ||||||||
| FaxNumber: | 5802335312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2011 | ||||||||
| LastUpdateDate: | 04/27/2011 | ||||||||
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| AuthorizedOfficialLastName: | PENA | ||||||||
| AuthorizedOfficialFirstName: | CRYSTAL | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | INSURANCE CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 4052727452 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.