Provider Demographics
NPI:1790127900
Name:BROKEN ARROW FAMILY PRACTICE CENTER PLC
Entity Type:Organization
Organization Name:BROKEN ARROW FAMILY PRACTICE CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF BAFPC PLC
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HOLTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-251-2273
Mailing Address - Street 1:817 S ELM PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5369
Mailing Address - Country:US
Mailing Address - Phone:918-251-2273
Mailing Address - Fax:918-258-6446
Practice Address - Street 1:817 S ELM PL
Practice Address - Street 2:SUITE A
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5369
Practice Address - Country:US
Practice Address - Phone:918-251-2273
Practice Address - Fax:918-258-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15244261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care