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General NPI Number Information
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NPI Number | 1639472970
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Entity Type | Organization
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Legal Business Name | CARNEGIE INDIAN HEALTH CLINIC
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Dates
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Enumeration Date | 12/08/2010
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Last Update Date | 12/08/2010
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Provider Practice Location Address
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Address Line | 212 E. 4TH ST
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City | CARNEGIE
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State | OK
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Zip | 73015
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Country | US
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Telephone | 580-654-1100
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Fax | 580-654-2273
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Provider Business Mailing Address
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Address Line | PO BOX 1120
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City | CARNEGIE
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State | OK
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Zip | 73015-1120
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Country | US
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Telephone | 580-654-1100
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Fax | 580-654-2533
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Authorized Official
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Title or Position | AREA DIRECTOR
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Name | JOHN DAUGHERTY
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Credential |
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Telephone | 405-951-3820
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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 | 83491
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License Number State | OK
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