Healthcare Provider Details

I. General information

NPI: 1568839470
Provider Name (Legal Business Name): OSAGE NATION SI-SI A-PE-TXA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
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: 918-287-9373
  • Fax: 918-287-1555
Mailing address:
  • Phone: 918-287-9300
  • Fax: 918-287-9343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number16-7405
License Number StateOK

VIII. Authorized Official

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