# ACACIA MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851400659
- **Authorized official:** KEITH WHITEHOUSE (ADMINISTRATOR/SECRETARY)
- **Authorized official phone:** (918) 258-2641

## Contact information

- **Practice address:** 2010 W HOUSTON ST, BROKEN ARROW, OK 74012-8303
- **Practice address phone:** (918) 258-2641
- **Practice address fax:** (918) 259-1905
- **Mailing address:** 2010 W HOUSTON ST, BROKEN ARROW, OK 74012-8303
- **Mailing address phone:** (918) 258-2641
- **Mailing address fax:** (918) 259-1905

## Taxonomy

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

## Other

- **Enumeration date:** 08/29/2006
- **Last updated:** 06/12/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200069800A | — | OK |