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General NPI Number Information
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NPI Number | 1104872456
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Entity Type | Organization
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Legal Business Name | IOWA TRIBE OF OKLAHOMA
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 501 E HIGHWAY 33
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City | PERKINS
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State | OK
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Zip | 74059
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Country | US
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Telephone | 405-547-2473
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Fax | 405-547-2925
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Provider Business Mailing Address
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Address Line | RR 1 BOX 721
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City | PERKINS
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State | OK
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Zip | 74059
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Country | US
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Telephone | 405-547-2473
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Fax | 405-547-2925
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Authorized Official
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Title or Position | TRIBAL ADMINISTRATOR
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Name | MR. TOD ROBERTSON
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Credential |
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Telephone | 405-547-2402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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