Healthcare Provider Details

I. General information

NPI: 1093402349
Provider Name (Legal Business Name): OSAGE NATION SI-SI A-PE-TXA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 E MAIN ST
PAWHUSKA OK
74056-5218
US

IV. Provider business mailing address

316 E MAIN ST
PAWHUSKA OK
74056-5218
US

V. Phone/Fax

Practice location:
  • Phone: 918-287-9300
  • Fax: 918-287-6138
Mailing address:
  • Phone: 918-287-9300
  • Fax: 918-287-6138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: HARRISON HUDGINS
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 918-287-9335