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Organization
BROKEN ARROW MEDICAL GROUP LLC
Active
Organization
BROKEN ARROW MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE T BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(877) 892-9813
Entity
Organization
Contact information
Practice address
9001 S. 101ST E. AVE, STE 350, TULSA, OK 74133
(918) 392-5500
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(888) 287-7705
(615) 465-2896
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
NULL
207V00000X
Obstetrics & Gynecology Physician
—
—
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200100460A
—
OK
Enumeration date
07/06/2006
Last updated
06/24/2011
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