MEDICARE: DEPT OF HEALTH AND HUMAN SERVICES PHS INDIAN HEALTH SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1578708475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEPT OF HEALTH AND HUMAN SERVICES PHS INDIAN HEALTH SERVICE

Provider Business Mailing Address
First Line	:	701 MARKET DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-8132
Country	:	US
Telephone Number	:	405-951-3820
Fax Number	:	405-951-3780

Provider Business Practice Location Address
First Line	:	701 MARKET DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-8132
Country	:	US
Telephone Number	:	405-951-3820
Fax Number	:	405-951-3780

Authorized Official
Title or Position	:	AREA DIRECTOR/ACTING
Name	:	TRAVIS WATTS JR.
Credential	:
Telephone Number	:	405-931-3829

Provider Enumeration Date	:	12/05/2008
Last Update Date	:	11/25/2019

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