| Broken Arrow Family Clinic Inc | |
|
705 W Oakland St Broken Arrow OK 74012-1656 | |
| (918) 251-2666 | |
| (918) 258-7790 |
| Full Name | Broken Arrow Family Clinic Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 705 W Oakland St, Broken Arrow, Oklahoma |
| Authorized Official Name and Position | Brian Coder (PRESIDENT) |
| Authorized Official Contact | 9182512666 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Broken Arrow Family Clinic Inc 705 W Oakland St Broken Arrow OK 74012-1656 Ph: (918) 251-2666 | Broken Arrow Family Clinic Inc 705 W Oakland St Broken Arrow OK 74012-1656 Ph: (918) 251-2666 |
| NPI Number | 1497966303 |
|---|---|
| Provider Enumeration Date | 05/24/2007 |
| Last Update Date | 05/16/2023 |
| Medicare PECOS PAC ID | 1153588355 |
|---|---|
| Medicare Enrollment ID | O20120131000041 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497966303 | NPI | - | NPPES |
| 100090910A | Medicaid | OK | |
| 100258080A | Medicaid | OK | |
| 100177740A | Medicaid | OK | |
| 100183270A | Medicaid | OK | |
| 100257900A | Medicaid | OK | |
| 1427164888 | Other | OK | BRIAN CODER NPI |
| 1679502173 | Other | OK | ARTHUR CODER NPI |
| 1811923949 | Other | OK | JAMES CODER NPI |
| 100090910B | Medicaid | OK | |
| 100178470A | Medicaid | OK | |
| 1001257870A | Medicaid | OK | |
| 1447234885 | Other | OK | CAROLE HOWARD NPI |
| Provider Name | Brian Coder |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427164888 PECOS PAC ID: 9739346925 Enrollment ID: I20120130000942 |
| Provider Name | Jayme Kenna Montgomery |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518525849 PECOS PAC ID: 5890141436 Enrollment ID: I20231102000699 |
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