Healthcare Provider Details

I. General information

NPI: 1407116668
Provider Name (Legal Business Name): CREEK NATION HOSPITAL & CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 S WASHITA ST
WETUMKA OK
74883-5522
US

IV. Provider business mailing address

MCN PHARMACY DEPT # 1249
TULSA OK
74182-0001
US

V. Phone/Fax

Practice location:
  • Phone: 405-452-1313
  • 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 Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number405693
License Number StateOK

VIII. Authorized Official

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