Organization · Type 2 NPI
Premise Health of Oklahoma Medical, P.c
Primary Care Clinic/Center · Broken Arrow, OK
NPI number
1861972291
Active
Practice location
1104 E Kenosha St
Broken Arrow, OK 74012-2067
Fax (918) 994-6897
Mailing address
5500 Maryland Way Ste 400
Brentwood, TN 37027-7048
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Primary Care Clinic/Center Primary | 261QP2300X | None listed |
Primary Care Clinic/Center: Definition to come...
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About NPI 1861972291
Premise Health of Oklahoma Medical, P.c's National Provider Identifier is 1861972291, issued on Aug 15, 2018. The primary taxonomy on file is Primary Care Clinic/Center (261QP2300X), and the practice location is in Broken Arrow, OK. The record was last updated on Oct 13, 2022.