1790030369 NPI number — CHEROKEE NATION

Table of content: (NPI 1790030369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790030369 NPI number — CHEROKEE NATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHEROKEE NATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VINITA HEALTH CENTER PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790030369
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT 2269
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74182-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-453-5636
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27371 S 4410 RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VINITA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74301-7953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-256-4848
Provider Business Practice Location Address Fax Number:
918-256-4594
Provider Enumeration Date:
07/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GRAHAM
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIR., HEALTH EDUCATION & STAFF DEV
Authorized Official Telephone Number:
539-234-1977

Provider Taxonomy Codes

  • Taxonomy code: 332800000X , with the licence number:  37-6011 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100239190B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2136086 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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