Provider Demographics
NPI:1457459158
Name:CARNEGIE INDIAN HEALTH CENTER
Entity Type:Organization
Organization Name:CARNEGIE INDIAN HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LENORA
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLEDEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-354-5407
Mailing Address - Street 1:1515 NE LAWRIE TATUM RD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507
Mailing Address - Country:US
Mailing Address - Phone:580-354-5150
Mailing Address - Fax:580-354-5148
Practice Address - Street 1:212 E. 4TH STREET
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:OK
Practice Address - Zip Code:73015
Practice Address - Country:US
Practice Address - Phone:580-654-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100231960DMedicaid
OK200119920AMedicaid
OK100700620QMedicaid
OK370170Medicare Oscar/Certification
OK100700620QMedicaid