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NPI Code Detail

MEDICARE: CITIZEN POTAWATOMI NATION WEST CLINIC

MEDICARE: CITIZEN POTAWATOMI NATION WEST CLINIC
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
1332800000XIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy105576OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598053993
Entity Type Code : Organization
Provider Name (Legal Business Name) : CITIZEN POTAWATOMI NATION WEST CLINIC
Provider Business Mailing Address
First Line : 781 GRAND CASINO BLVD
Second Line :
City : SHAWNEE
State : OK
Zip : 74804-1005
Country : US
Telephone Number : 405-964-5770
Fax Number : 405-964-5785
Provider Business Practice Location Address
First Line : 781 GRAND CASINO BLVD
Second Line :
City : SHAWNEE
State : OK
Zip : 74804-1005
Country : US
Telephone Number : 405-964-5770
Fax Number : 405-964-5785
Authorized Official
Title or Position : BUSINESS OFFICE COORDINATOR
Name : AUBRY BENNETT
Credential : CPC-A
Telephone Number : 405-964-4025
Provider Enumeration Date : 07/19/2011
Last Update Date : 05/18/2026

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1023352721 — MISS MARY E ZIENTEK RN
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1861895518 — CHRISTINE VENCL LPN
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Directions to “CITIZEN POTAWATOMI NATION WEST CLINIC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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