BROADWAY, ERIC STARK - Licensee Information

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Last Update: Thursday, December 19, 2024 3:44 AM CST
Next Update: Thursday, December 19, 2024 12:00 PM CST

BROADWAY, ERIC STARK

This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.

Practice Address:	HEALTH & WELLNESS CENTER 1505 EAST MAIN STIGLER OK 74462-2804 Address last updated on 5/10/2024
Phone #:	(918) 967-3368 x2216
Fax #:	(918) 967-4582
County:	HASKELL
License:	16956
Dated:	7/1/1989
Expires:	7/1/2025
Training Issued:	6/13/1988
Training Expires:	9/30/1989
License Type:	Medical Doctor
Specialty:	Psychiatry

Status:	Active
Status Class:	Fully Licensed
Restricted to:
Registered to Dispense:	NO
Medical School:	Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduated:	6 / 1988
CME Year:	2027

Pending and/or Past Disciplinary Actions:

Date

Action

Reasons

Remarks

9/17/2014

Probation Ended

1/14/2010

Modification Order

9/17/2009

Probation

4/15/2009

Complaint Citation

Board Filings and/or Orders:
01/14/2010
09/17/2009
04/15/2009
04/15/2009

All information below is entered by the licensee but not verified by the Oklahoma Medical Board.

Certifications:
New Patients:	Yes
Medicaid:	Yes
Medicare:	Yes

HMO/PPO:	Aetna HMO Aetna PPO BlueChoice PPO BlueLincs HMO HealthChoice PacifiCare of Oklahoma, Inc Preferred Community Choice Prudential Health Care Plan, Inc UniCare Health Plans of Oklahoma United Healthcare HMO United Healthcare Options PPO
Hospital Privileges:	None listed

Locations:	Hours:	Languages:
HEALTH & WELLNESS CENTER 1505 EAST MAIN STIGLER OK 74462-2804 Phone #: (918) 967-3368 x2216 Fax #: (918) 967-4582	Mon: Tue: Wed: Thu: Fri: Sat: Sun:
1630 S Kerr Blvd Sallisaw, OK 74955 Phone #: (918) 790-2653 Fax #: (8) 201-	Mon: Tue: Wed: Thu: Fri: 8:30AM - 5:00PM Mon Wed Sat: Sun:
1120 Tarby Rd Poteau, OK 74953 Phone #: (918) 647-2155 Fax #: (8) 202-	Mon: Tue: Wed: Thu: Fri: 8:30AM - 5:00PM Mon Tue and Thur Sat: Sun:

Name:	Type:	License Number:
Primary Supervisees(s):
ERIN HAYTAIAN	APRN	123872
LORIE SHULER	APRN	134311

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