Broken Arrow Diagnostic Medicine, Pllc
LBN: Broken Arrow Diagnostic Medicine, Pllc
Broken Arrow Diagnostic Medicine, Pllc is an health care organization with primary practice located at 110 N 1St St , Broken Arrow OK 74012-3945. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty.
Broken Arrow Diagnostic Medicine, Pllc can be contacted via phone (918) 994-5140, or through Callison, Jacob Leon via phone (918) 994-5140.
Contact Information
Primary practice address
110 N 1St St
Broken Arrow OK 74012-3945
Phone: (918) 994-5140
Fax: (918) 994-5150
Website:
Authorized official contact:
Name: Callison, Jacob Leon Physician Assistant (PA)
Phone: (918) 994-5140
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | Oklahoma |
Profile Details
| NPI number | 1710322672 |
|---|---|
| LBN Legal business name | Broken Arrow Diagnostic Medicine, Pllc |
| DBA Doing business as | |
| Authorized official | Callison, Jacob Leon Physician Assistant (PA) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | May 6th, 2013 |
| Last updated | Apr 10th, 2023 - about last year |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1710322672 | NPPES |
| Oklahoma | MEDICAID | 200520620A | |
| Oklahoma | Other | 1487885877 | |
| Oklahoma | Other | 1700851052 |
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