Healthcare Provider Details

I. General information

NPI: 1457447609
Provider Name (Legal Business Name): INDIAN HEALTH CARE RESOURCE CENTER OF TULSA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 S. PEORIA AVENUE
TULSA OK
74120
US

IV. Provider business mailing address

550 S. PEORIA AVENUE
TULSA OK
74120-3825
US

V. Phone/Fax

Practice location:
  • Phone: 918-588-1900
  • Fax: 918-382-1285
Mailing address:
  • Phone: 918-588-1900
  • Fax: 918-582-6405

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 Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARMELITA SKEETER
Title or Position: CEO
Credential:
Phone: 918-382-1201