Healthcare Provider Details

I. General information

NPI: 1699118521
Provider Name (Legal Business Name): CREEK NATION HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1943 SOUTH WATER
SAPULPA OK
74066
US

IV. Provider business mailing address

1943 S WATER ST
SAPULPA OK
74066-6532
US

V. Phone/Fax

Practice location:
  • Phone: 918-227-3800
  • Fax:
Mailing address:
  • Phone: 918-227-3800
  • Fax: 918-224-9309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN FERRIS (HAWK) COCKE'
Title or Position: HIV EDUCATOR/STI/TESTER
Credential: AA
Phone: 918-227-3800