Provider Demographics
NPI:1104198936
Name:EL RENO INDIAN HEALTH CENTER
Entity Type:Organization
Organization Name:EL RENO INDIAN HEALTH CENTER
Other - Org Name:INDIAN HEALTH SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLELLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:580-331-3314
Mailing Address - Street 1:1801 N PARKVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036
Mailing Address - Country:US
Mailing Address - Phone:580-331-3300
Mailing Address - Fax:
Practice Address - Street 1:1801 N PARKVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036
Practice Address - Country:US
Practice Address - Phone:580-331-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPARTMENT OF HEALTH AND HUMAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-09
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR006447261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center