=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427034958
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INDIAN HEALTH CARE RESOURCE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2005
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 SOUTH PEORIA AVE
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74120-3820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-588-1900
-----------------------------------------------------
Fax | 918-582-8552
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 S PEORIA AVE
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74120-3820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-588-1900
-----------------------------------------------------
Fax | 918-582-8552
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | DEANNA E HOLMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-588-1900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------