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General NPI Number Information
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NPI Number | 1689664195
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Entity Type | Organization
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Legal Business Name | WEWOKA INDIAN HEALTH
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 02/23/2021
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Provider Practice Location Address
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Address Line | 36640 HWY 270
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City | WEWOKA
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State | OK
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Zip | 74884
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Country | US
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Telephone | 405-257-6282
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Fax | 405-257-2696
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Provider Business Mailing Address
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Address Line | PO BOX 1475
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City | WEWOKA
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State | OK
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Zip | 74884-1475
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Country | US
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Telephone | 405-257-7318
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Fax | 405-257-2696
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Authorized Official
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Title or Position | CEO
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Name | MR. FARREL SMITH
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Credential |
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Telephone | 405-257-6282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State | OK
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