Provider Demographics
NPI:1407116668
Name:CREEK NATION HOSPITAL & CLINICS
Entity Type:Organization
Organization Name:CREEK NATION HOSPITAL & CLINICS
Other - Org Name:WETUMKA INDIAN HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY OF HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:918-756-9909
Mailing Address - Street 1:MCN PHARMACY
Mailing Address - Street 2:DEPT # 1249
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74182-0001
Mailing Address - Country:US
Mailing Address - Phone:918-756-9909
Mailing Address - Fax:918-756-2464
Practice Address - Street 1:325 S WASHITA ST
Practice Address - Street 2:
Practice Address - City:WETUMKA
Practice Address - State:OK
Practice Address - Zip Code:74883-5522
Practice Address - Country:US
Practice Address - Phone:405-452-1313
Practice Address - Fax:918-756-2464
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUSCOGEE (CREEK) NATION DEPARTMENT OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-22
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK405693332800000X
333600000X, 3336C0002X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135264OtherPK