1780841734 NPI number — CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL, INC.

Table of content: (NPI 1780841734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780841734 NPI number — CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL, INC.
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:
OKLAHOMA CITY INDIAN CLINIC LABORATORY
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:
1780841734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4913 W RENO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73127-6339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-948-4900
Provider Business Mailing Address Fax Number:
405-948-4936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4913 W RENO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73127-6339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-948-4900
Provider Business Practice Location Address Fax Number:
405-948-4936
Provider Enumeration Date:
05/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SUNDAY-ALLEN
Authorized Official First Name:
ROBYN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
405-948-4900

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 37D0663081 . This is a "CLIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 37D2025076 . This is a "CLIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100731010A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 371818 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".




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