1023049350 NPI number — CREEK NATION HOSPITAL AND CLINICS

Table of content: (NPI 1023049350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023049350 NPI number — CREEK NATION HOSPITAL AND CLINICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREEK NATION HOSPITAL AND CLINICS
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:
Provider Other Organization Name Type Code:
6
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:
1023049350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT 1467
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:
918-756-3334
Provider Business Mailing Address Fax Number:
918-756-3993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1313 E 20TH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKMULGEE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-756-0206
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TERRY
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY OF HEALTH
Authorized Official Telephone Number:
918-756-4333

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 730932018009 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100700620F , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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