Healthcare Provider Details

I. General information

NPI: 1245843796
Provider Name (Legal Business Name): CREEK NATION HOSPITAL & CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10109 E 79TH ST STE B120
TULSA OK
74133-4564
US

IV. Provider business mailing address

MCN PHARMACY DEPT #1249
TULSA OK
74182-0001
US

V. Phone/Fax

Practice location:
  • Phone: 918-300-1061
  • Fax: 918-756-2464
Mailing address:
  • Phone: 918-756-9909
  • Fax: 918-756-2464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHAWN TERRY
Title or Position: SECRETARY OF HEALTH
Credential:
Phone: 918-756-9909