Basic Information
| Provider Information | |||||||||
| NPI: | 1518224260 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | USPHS INDIAN HEALTH SERVICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10321 N 2274 RD | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 736017521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803313300 | ||||||||
| FaxNumber: | 5803232579 | ||||||||
| Practice Location | |||||||||
| Address1: | RR 1 BOX 34A | ||||||||
| Address2: | |||||||||
| City: | WATONGA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 737729706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5806234991 | ||||||||
| FaxNumber: | 5806235490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2012 | ||||||||
| LastUpdateDate: | 04/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | CLELLAND | ||||||||
| AuthorizedOfficialFirstName: | CARMEN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5803313314 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHARMD, MPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 3568 | OK | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.