Provider Demographics
NPI:1457447609
Name:INDIAN HEALTH CARE RESOURCE CENTER OF TULSA, INC.
Entity Type:Organization
Organization Name:INDIAN HEALTH CARE RESOURCE CENTER OF TULSA, INC.
Other - Org Name:IHCRC PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMELITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SKEETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-382-1201
Mailing Address - Street 1:550 S. PEORIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-3825
Mailing Address - Country:US
Mailing Address - Phone:918-588-1900
Mailing Address - Fax:918-582-6405
Practice Address - Street 1:550 S. PEORIA AVENUE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-3825
Practice Address - Country:US
Practice Address - Phone:918-588-1900
Practice Address - Fax:918-582-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1427034958OtherIHCRC NPI