Healthcare Provider Details

I. General information

NPI: 1700977808
Provider Name (Legal Business Name): DHHS US PUBLIC HEALTH SERVICE INDIAN HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101S MOORE AVE
CLAREMORE OK
74017-5047
US

IV. Provider business mailing address

715 GRANDVIEW AVE
PAWHUSKA OK
74056
US

V. Phone/Fax

Practice location:
  • Phone: 918-287-4491
  • Fax: 918-287-2347
Mailing address:
  • Phone: 918-287-4491
  • Fax: 918-287-2347

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: MRS. AMY D EDEN
Title or Position: BUSINESS OFFICE MANAGER
Credential: MPH
Phone: 918-287-4491