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	302F00000X	Exclusive Provider Organization

General Provider Information

NPI Number	:	1902344328
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	:	405-951-3815
Fax Number	:	405-951-3916

Provider Business Practice Location Address
First Line	:	701 MARKET DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-8132
Country	:	US
Telephone Number	:	405-951-3815
Fax Number	:	405-951-3916

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	ANGIE CAROL JENNINGS
Credential	:
Telephone Number	:	405-615-8971

Provider Enumeration Date	:	02/06/2017
Last Update Date	:	02/06/2017

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