BROKEN ARROW DIAGNOSTIC MEDICINE PLLC NPI 1710322672

NPI Information

  • NPI: 1710322672
  • Provider Name: BROKEN ARROW DIAGNOSTIC MEDICINE, PLLC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Address: 5050 E KENOSHA ST
    BROKEN ARROW, OK
    ZIP 74014
  • Phone: (918) 994-5140

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NPI Details

BROKEN ARROW DIAGNOSTIC MEDICINE, PLLC is a family medicine in Broken Arrow, OK. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. BROKEN ARROW DIAGNOSTIC MEDICINE, PLLC NPI is 1710322672. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

5050 E KENOSHA ST
BROKEN ARROW, OK
ZIP 74014-711
Phone: (918) 994-5140
Fax: (918) 994-5150

The provider's authorized official is Jacob Leon Callison .
The authorized official title is Managing Member and has the following contact phone number (918) 994-5140.

The enumeration date for this NPI number is 5/6/2013 and was last updated on 10/8/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineOKLAHOMAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1200520620AMEDICAIDOKLAHOMA
21700851052OTHEROKLAHOMANPI
31487885877OTHEROKLAHOMANPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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