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General NPI Number Information
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NPI Number | 1265518203
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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 | 10/31/2006
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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 | 405-964-2053
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Provider Business Mailing Address
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Address Line | PO BOX 1360
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City | MCLOUD
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State | OK
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Zip | 74851-1360
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Country | US
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Telephone | 405-964-2081
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Fax | 405-964-2053
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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