Provider Demographics
NPI:1629419726
Name:OPEN ARMS CLINIC
Entity Type:Organization
Organization Name:OPEN ARMS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SACKET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-789-0458
Mailing Address - Street 1:5252 N MERIDIAN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2136
Mailing Address - Country:US
Mailing Address - Phone:405-789-0458
Mailing Address - Fax:405-787-0184
Practice Address - Street 1:5252 N MERIDIAN AVE STE 101
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2136
Practice Address - Country:US
Practice Address - Phone:405-789-0458
Practice Address - Fax:405-787-0184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-61713336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy