Healthcare Provider Details

I. General information

NPI: 1811540362
Provider Name (Legal Business Name): PEORIA TRIBE OF INDIANS OF OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 S EIGHT TRIBES TRL
MIAMI OK
74354-1002
US

IV. Provider business mailing address

118 S EIGHT TRIBES TRL
MIAMI OK
74354-1002
US

V. Phone/Fax

Practice location:
  • Phone: 918-540-2535
  • Fax:
Mailing address:
  • Phone: 918-540-2535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: JORDAN BARLOW
Title or Position: PROGRAM DEVELOPMENT SPECIALIST
Credential:
Phone: 918-540-2535