Healthcare Provider Details

I. General information

NPI: 1073968855
Provider Name (Legal Business Name): USPHS/IHS/WEWOKA INDIAN HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36640 HWY 270
WEWOKA OK
74884-1475
US

IV. Provider business mailing address

PO BOX 1475
WEWOKA OK
74884-1475
US

V. Phone/Fax

Practice location:
  • Phone: 405-257-7361
  • Fax: 405-257-3344
Mailing address:
  • Phone: 405-257-7361
  • Fax: 405-257-3344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number14343
License Number StateOK

VIII. Authorized Official

Name: DR. SHANNON MICHELLE LOWE
Title or Position: ASSISTANT DIRECTOR OF PHARMACY
Credential: PHARMD
Phone: 405-257-7361