# FAMILY CARE OF BROKEN ARROW, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Family Medicine Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053431452
- **Authorized official:** DR. LEROY O. JESKE D.O. (MEDICAL DIRECTOR D.O.)
- **Authorized official phone:** (918) 455-7777

## Contact information

- **Practice address:** 3100 S. ELM PL., SUITE A, BROKEN ARROW, OK 74012-7910
- **Practice address phone:** (918) 455-7777
- **Practice address fax:** (918) 455-8105
- **Mailing address:** 3100 S. ELM PL., SUITE A, BROKEN ARROW, OK 74012-7910
- **Mailing address phone:** (918) 455-7777
- **Mailing address fax:** (918) 455-8105

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/30/2007
- **Last updated:** 04/20/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0749960001 | PTAN/DMERC | OK |
| 01 | — | CS2603 | RAILROAD MEDICARE | OK |