Healthcare Provider Details

I. General information

NPI: 1689664195
Provider Name (Legal Business Name): WEWOKA INDIAN HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 02/23/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36640 HWY 270
WEWOKA OK
74884
US

IV. Provider business mailing address

PO BOX 1475
WEWOKA OK
74884-1475
US

V. Phone/Fax

Practice location:
  • Phone: 405-257-6282
  • Fax: 405-257-2696
Mailing address:
  • Phone: 405-257-7318
  • Fax: 405-257-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateOK

VIII. Authorized Official

Name: MR. FARREL SMITH
Title or Position: CEO
Credential:
Phone: 405-257-6282