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General NPI Number Information
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NPI Number | 1205795143
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Entity Type | Organization
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Legal Business Name | RED BERRY HEALTH SYSTEM
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Dates
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Enumeration Date | 01/16/2026
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 6403 W GORE BLVD
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City | LAWTON
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State | OK
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Zip | 73505-5801
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Country | US
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Telephone | 580-699-5333
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Fax |
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Provider Business Mailing Address
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Address Line | 584 NW BINGO RD
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City | LAWTON
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State | OK
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Zip | 73507-1214
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Country | US
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Telephone | 580-360-5450
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN
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Name | FORREST TAHDOOAHNIPPAH
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Credential |
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Telephone | 580-360-5450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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