| Broken Arrow Diagnostic Medicine, Pllc | |
|
5050 E Kenosha St Broken Arrow OK 74014-6711 | |
| (918) 994-5140 | |
| (918) 994-5150 |
| Full Name | Broken Arrow Diagnostic Medicine, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 5050 E Kenosha St, Broken Arrow, Oklahoma |
| Authorized Official Name and Position | Jacob Leon Callison (MANAGING MEMBER) |
| Authorized Official Contact | 9189945140 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Broken Arrow Diagnostic Medicine, Pllc 5050 E Kenosha St Broken Arrow OK 74014-6711 Ph: (918) 994-5140 | Broken Arrow Diagnostic Medicine, Pllc 5050 E Kenosha St Broken Arrow OK 74014-6711 Ph: (918) 994-5140 |
| NPI Number | 1710322672 |
|---|---|
| Provider Enumeration Date | 05/06/2013 |
| Last Update Date | 10/08/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710322672 | NPI | - | NPPES |
| 200520620A | Medicaid | OK | |
| 1700851052 | Other | OK | NPI |
| 1487885877 | Other | OK | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Oklahoma) | Primary |
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