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General NPI Number Information
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NPI Number | 1194803346
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Entity Type | Organization
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Legal Business Name | KICKAPOO TRIBAL HEALTH CENTER
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 105365 S. HWY 102 BUILDING M
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City | MCLOUD
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State | OK
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Zip | 74851
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Country | US
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Telephone | 405-964-2081
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Fax | 405-964-7160
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Provider Business Mailing Address
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Address Line | 105365 S. HWY 102 BUILDING M
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City | MCLOUD
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State | OK
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Zip | 74851
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Country | US
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Telephone | 405-964-2081
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Fax | 405-964-7160
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Authorized Official
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Title or Position | HEALTH DIRECTOR
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Name | MR. WAYNE IRION
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Credential |
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Telephone | 405-964-2081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332800000X
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Taxonomy Name | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
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License Number |
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License Number State |
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