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General NPI Number Information
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NPI Number | 1639267065
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Entity Type | Organization
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Legal Business Name | NORTHEASTERN TRIBAL HEALTH SYSTEM
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 12/19/2012
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Provider Practice Location Address
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Address Line | 7600 S HIGHWAY 69A
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City | MIAMI
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State | OK
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Zip | 74354-1016
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Country | US
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Telephone | 918-542-1655
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Fax | 918-540-1685
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Provider Business Mailing Address
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Address Line | PO BOX 1498
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City | MIAMI
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State | OK
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Zip | 74355-1498
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Country | US
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Telephone | 918-542-1655
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Fax | 918-540-1685
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Authorized Official
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Title or Position | HEALTH PROGRAM DIRECTOR
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Name | SHARON DAWES
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Credential |
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Telephone | 918-542-1655
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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 | 21-4318
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License Number State | OK
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