Provider Demographics
NPI:1407969728
Name:CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL, INC.
Entity Type:Organization
Organization Name:CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL, INC.
Other - Org Name:OKLAHOMA CITY INDIAN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF POLICY DEVELOPMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-948-4900
Mailing Address - Street 1:4913 W RENO AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-6339
Mailing Address - Country:US
Mailing Address - Phone:405-948-4900
Mailing Address - Fax:405-948-4933
Practice Address - Street 1:4913 W RENO AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-6339
Practice Address - Country:US
Practice Address - Phone:405-948-4900
Practice Address - Fax:405-948-4933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100731010EMedicaid
OK100731010AMedicaid
OK100731010EMedicaid
OK371888Medicare PIN
OKHSZ251Medicare PIN
OK=========-001OtherBCBS PAYOR ID
OK100731010AMedicaid