Healthcare Provider Details

I. General information

NPI: 1558458794
Provider Name (Legal Business Name): WATONGA INDIAN HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 34A
WATONGA OK
73772-9706
US

IV. Provider business mailing address

RR 1 BOX 34A
WATONGA OK
73772-9706
US

V. Phone/Fax

Practice location:
  • Phone: 580-623-4991
  • Fax: 580-623-5490
Mailing address:
  • Phone: 580-623-4991
  • Fax: 580-623-5490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOE BRYANT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 580-331-3315