Healthcare Provider Details

I. General information

NPI: 1871663203
Provider Name (Legal Business Name): SAC & FOX NATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356110 E 930 RD
STROUD OK
74079-5184
US

IV. Provider business mailing address

356110 E 930 RD
STROUD OK
74079-5184
US

V. Phone/Fax

Practice location:
  • Phone: 918-968-9531
  • Fax: 918-968-9057
Mailing address:
  • Phone: 918-968-9531
  • Fax: 918-968-9057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHERI BROWN
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 918-968-9531