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General NPI Number Information
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NPI Number | 1871663203
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Entity Type | Organization
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Legal Business Name | SAC & FOX NATION
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 356110 E 930 RD
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City | STROUD
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State | OK
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Zip | 74079-5184
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Country | US
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Telephone | 918-968-9531
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Fax | 918-968-9057
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Provider Business Mailing Address
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Address Line | 356110 E 930 RD
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City | STROUD
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State | OK
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Zip | 74079-5184
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Country | US
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Telephone | 918-968-9531
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Fax | 918-968-9057
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | SHERI BROWN
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Credential |
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Telephone | 918-968-9531
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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