Provider Demographics
NPI:1366455420
Name:SAC & FOX NATION
Entity Type:Organization
Organization Name:SAC & FOX NATION
Other - Org Name:BLACK HAWK HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-968-9531
Mailing Address - Street 1:RR 2 BOX 247
Mailing Address - Street 2:
Mailing Address - City:STROUD
Mailing Address - State:OK
Mailing Address - Zip Code:74079-9652
Mailing Address - Country:US
Mailing Address - Phone:918-968-9531
Mailing Address - Fax:918-968-0113
Practice Address - Street 1:RR 2 BOX 247
Practice Address - Street 2:
Practice Address - City:STROUD
Practice Address - State:OK
Practice Address - Zip Code:74079-9652
Practice Address - Country:US
Practice Address - Phone:918-968-9531
Practice Address - Fax:918-968-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3723269OtherNCPDP
OK100729660CMedicaid