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General NPI Number Information
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NPI Number | 1891999157
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Entity Type | Organization
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Legal Business Name | WHITE EAGLE HEALTH CENTER
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 200 WHITE EAGLE DRIVE
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City | PONCA CITY
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State | OK
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Zip | 74601
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Country | US
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Telephone | 580-765-2501
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Fax | 580-765-0984
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Provider Business Mailing Address
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Address Line | 200 WHITE EAGLE DRIVE
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City | PONCA CITY
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State | OK
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Zip | 74601
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Country | US
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Telephone | 580-765-2501
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Fax | 580-765-0984
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Authorized Official
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Title or Position | DIRECTOR
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Name | DEBORAH MARGERUM
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Credential |
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Telephone | 580-765-2501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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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