Healthcare Provider Details

I. General information

NPI: 1457459158
Provider Name (Legal Business Name): CARNEGIE INDIAN HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E. 4TH STREET
CARNEGIE OK
73015
US

IV. Provider business mailing address

1515 NE LAWRIE TATUM RD
LAWTON OK
73507
US

V. Phone/Fax

Practice location:
  • Phone: 580-654-1100
  • Fax:
Mailing address:
  • Phone: 580-354-5150
  • Fax: 580-354-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRIAN R WREN
Title or Position: CEO
Credential:
Phone: 580-354-5407