Organization
ACACIA MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH WHITEHOUSE (ADMINISTRATOR/SECRETARY)
(918) 258-2641
Entity
Organization
Contact information
Practice address
2010 W HOUSTON ST, BROKEN ARROW, OK 74012-8303
(918) 258-2641
(918) 259-1905
Mailing address
2010 W HOUSTON ST, BROKEN ARROW, OK 74012-8303
(918) 258-2641
(918) 259-1905
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200069800A
—
OK
Enumeration date
08/29/2006
Last updated
06/12/2008
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