Provider Demographics
NPI:1083231724
Name:BROKEN ARROW PEDIATRIC BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:BROKEN ARROW PEDIATRIC BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BEETS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-752-4403
Mailing Address - Street 1:502 W ATLANTA ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7004
Mailing Address - Country:US
Mailing Address - Phone:918-752-4403
Mailing Address - Fax:
Practice Address - Street 1:502 W ATLANTA ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7004
Practice Address - Country:US
Practice Address - Phone:918-752-4403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty