Healthcare Provider Details

I. General information

NPI: 1699825489
Provider Name (Legal Business Name): CARNEIGIE INDIAN HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/08/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E 4TH STREET
CARNEGIE OK
73015
US

IV. Provider business mailing address

212 E 4TH STREET
CARNEGIE OK
73015
US

V. Phone/Fax

Practice location:
  • Phone: 580-654-2533
  • Fax:
Mailing address:
  • Phone: 580-654-2533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number20-3906
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KAILEEN SKIDGEL
Title or Position: OCA PHARMACY CONSULTANT
Credential:
Phone: 918-762-6611