Healthcare Provider Details

I. General information

NPI: 1942253521
Provider Name (Legal Business Name): ABSENTEE SHAWNEE TRIBAL HEALTH AUTHORITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 S GORDON COOPER DRIVE
SHAWNEE OK
74801
US

IV. Provider business mailing address

15951 LITTLE AXE DR
NORMAN OK
73026-9088
US

V. Phone/Fax

Practice location:
  • Phone: 405-878-5850
  • Fax: 405-214-4227
Mailing address:
  • Phone: 405-447-0300
  • Fax: 405-701-7914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateOK

VIII. Authorized Official

Name: MARTY LOFGREN
Title or Position: MEDICAL DIRECTOR
Credential: MD, CPE
Phone: 405-447-0300