Healthcare Provider Details

I. General information

NPI: 1629419726
Provider Name (Legal Business Name): OPEN ARMS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5252 N MERIDIAN AVE STE 101
OKLAHOMA CITY OK
73112-2136
US

IV. Provider business mailing address

5252 N MERIDIAN AVE STE 101
OKLAHOMA CITY OK
73112-2136
US

V. Phone/Fax

Practice location:
  • Phone: 405-789-0458
  • Fax: 405-787-0184
Mailing address:
  • Phone: 405-789-0458
  • Fax: 405-787-0184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number1-6171
License Number StateOK

VIII. Authorized Official

Name: STEVEN K. SACKET
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 405-789-0458