Healthcare Provider Details

I. General information

NPI: 1518224260
Provider Name (Legal Business Name): USPHS INDIAN HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 04/19/2012
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

10321 N 2274 RD
CLINTON OK
73601-7521
US

V. Phone/Fax

Practice location:
  • Phone: 580-623-4991
  • Fax: 580-623-5490
Mailing address:
  • Phone: 580-331-3300
  • Fax: 580-323-2579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number3568
License Number StateOK

VIII. Authorized Official

Name: CARMEN C CLELLAND
Title or Position: CEO
Credential: PHARMD, MPA
Phone: 580-331-3314