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General NPI Number Information
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NPI Number | 1700977808
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Entity Type | Organization
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Legal Business Name | DHHS US PUBLIC HEALTH SERVICE INDIAN HEALTH SERVICE
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 08/31/2009
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Provider Practice Location Address
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Address Line | 101S MOORE AVE
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City | CLAREMORE
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State | OK
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Zip | 74017-5047
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Country | US
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Telephone | 918-287-4491
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Fax | 918-287-2347
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Provider Business Mailing Address
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Address Line | 715 GRANDVIEW AVE
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City | PAWHUSKA
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State | OK
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Zip | 74056
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Country | US
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Telephone | 918-287-4491
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Fax | 918-287-2347
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MRS. AMY D EDEN
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Credential | MPH
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Telephone | 918-287-4491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP0904X
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Taxonomy Name | Federal Public Health Clinic/Center
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License Number |
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License Number State |
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