| Acacia Medical Group | |
|
2010 W Houston St Broken Arrow OK 74012-8303 | |
| (918) 258-2641 | |
| (918) 259-1905 |
| Full Name | Acacia Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 2010 W Houston St, Broken Arrow, Oklahoma |
| Authorized Official Name and Position | Keith Whitehouse (ADMINISTRATOR/SECRETARY) |
| Authorized Official Contact | 9182582641 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Acacia Medical Group 2010 W Houston St Broken Arrow OK 74012-8303 Ph: (918) 258-2641 | Acacia Medical Group 2010 W Houston St Broken Arrow OK 74012-8303 Ph: (918) 258-2641 |
| NPI Number | 1851400659 |
|---|---|
| Provider Enumeration Date | 08/29/2006 |
| Last Update Date | 06/12/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851400659 | NPI | - | NPPES |
| 200069800A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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