1497934335 NPI number — CREEK NATION HOSPITAL & CLINICS

Table of content: (NPI 1497934335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497934335 NPI number — CREEK NATION HOSPITAL & CLINICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREEK NATION HOSPITAL & 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:
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:
1497934335
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1312
Provider Second Line Business Mailing Address:
FNB DEPT 001
Provider Business Mailing Address City Name:
OKMULGEE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74447-1312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-756-3334
Provider Business Mailing Address Fax Number:
918-759-2081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 W FORREST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUFAULA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74432-3249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-689-2547
Provider Business Practice Location Address Fax Number:
918-689-2164
Provider Enumeration Date:
10/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KAISER
Authorized Official First Name:
CRYSTAL
Authorized Official Middle Name:
DAWN
Authorized Official Title or Position:
DIABETES DIETITIAN
Authorized Official Telephone Number:
918-689-2547

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  1542 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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