Healthcare Provider Details

I. General information

NPI: 1225295272
Provider Name (Legal Business Name): CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4913 W RENO AVE
OKLAHOMA CITY OK
73127-6339
US

IV. Provider business mailing address

4913 W RENO AVE
OKLAHOMA CITY OK
73127-6339
US

V. Phone/Fax

Practice location:
  • Phone: 405-948-4900
  • Fax: 405-948-4919
Mailing address:
  • Phone: 405-948-4900
  • Fax: 405-948-4919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ROBYN R SUNDAY-ALLEN
Title or Position: CEO
Credential: MPH, RN
Phone: 405-948-4900