Healthcare Provider Details

I. General information

NPI: 1578708475
Provider Name (Legal Business Name): DEPT OF HEALTH AND HUMAN SERVICES PHS INDIAN HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MARKET DR
OKLAHOMA CITY OK
73114-8132
US

IV. Provider business mailing address

701 MARKET DR
OKLAHOMA CITY OK
73114-8132
US

V. Phone/Fax

Practice location:
  • Phone: 405-951-3820
  • Fax: 405-951-3780
Mailing address:
  • Phone: 405-951-3820
  • Fax: 405-951-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TRAVIS WATTS JR.
Title or Position: AREA DIRECTOR/ACTING
Credential:
Phone: 405-931-3829