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General NPI Number Information
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NPI Number | 1942253521
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Entity Type | Organization
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Legal Business Name | ABSENTEE SHAWNEE TRIBAL HEALTH AUTHORITY, INC.
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 2029 S GORDON COOPER DRIVE
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City | SHAWNEE
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State | OK
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Zip | 74801
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Country | US
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Telephone | 405-878-5850
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Fax | 405-214-4227
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Provider Business Mailing Address
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Address Line | 15951 LITTLE AXE DR
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City | NORMAN
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State | OK
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Zip | 73026-9088
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Country | US
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Telephone | 405-447-0300
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Fax | 405-701-7914
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MARTY LOFGREN
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Credential | MD, CPE
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Telephone | 405-447-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State | OK
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