=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891968491
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CREEK NATION HOSPITAL & CLINICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2008
-----------------------------------------------------
Last Update Date | 04/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 E 4TH ST LACKEY HALL SOUTH
-----------------------------------------------------
City | OKMULGEE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74447-3942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-756-4333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 400
-----------------------------------------------------
City | OKMULGEE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74447-0400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | JUDY AARON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-756-4333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------