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General NPI Number Information
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NPI Number | 1417802224
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Entity Type | Organization
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Legal Business Name | KEETOOWAH HEALTHCARE SERVICES, LLC
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Dates
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Enumeration Date | 02/27/2026
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Last Update Date | 02/27/2026
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Provider Practice Location Address
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Address Line | 16414 W 760 RD
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City | TAHLEQUAH
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State | OK
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Zip | 74464-1675
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Country | US
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Telephone | 918-525-9595
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Fax | 918-525-9590
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Provider Business Mailing Address
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Address Line | PO BOX 1245
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City | TAHLEQUAH
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State | OK
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Zip | 74465-1245
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Country | US
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Telephone | 918-525-9595
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Fax | 918-525-9590
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Authorized Official
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Title or Position | EXECUTIVE
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Name | FREDO ANDERSON
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Credential |
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Telephone | 918-395-6699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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