Healthcare Provider Details

I. General information

NPI: 1205923448
Provider Name (Legal Business Name): CLINTON INDIAN HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10321 N 2274 RD
CLINTON OK
73601-7521
US

IV. Provider business mailing address

RR 1 BOX 3060
CLINTON OK
73601-9303
US

V. Phone/Fax

Practice location:
  • Phone: 580-331-3404
  • Fax: 580-331-3565
Mailing address:
  • Phone: 580-331-3404
  • Fax: 580-331-3565

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: MR. JOE BRYANT
Title or Position: AREA DIRECTOR
Credential:
Phone: 580-331-3315