Broken Arrow Diagnostic Medicine, PLLC
Family Medicine in Broken Arrow, OK. Organization (NPI-2).
NPI number1710322672
StatusActive
Last updated in NPPESOct 8, 2024
Details
- NPI
- 1710322672
- Entity type
- Organization (NPI-2)
- Legal business name
- Broken Arrow Diagnostic Medicine, PLLC
- Organization subpart
- No
- Enumeration date
- May 6, 2013
- Certification date
- Oct 8, 2024
- Last updated
- Oct 8, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | OK | Yes |
Practice location
5050 E Kenosha StBroken Arrow, OK 74014-6711
Phone 918-994-5140 · Fax 918-994-5150
Mailing address
5050 E Kenosha StBroken Arrow, OK 74014-6711
Phone 918-994-5140 · Fax 918-994-5150
Authorized official
Jacob Leon Callison
Managing Member
9189945140
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