Provider Demographics
NPI:1497791859
Name:CHEROKEE NATION
Entity Type:Organization
Organization Name:CHEROKEE NATION
Other - Org Name:WILMA P MANKILLER HEALTH CENTER RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR., HEALTH EDUCATION & STAFF DEV
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:539-234-1977
Mailing Address - Street 1:CHEROKEE NATION
Mailing Address - Street 2:DEPT 2269
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74182-0001
Mailing Address - Country:US
Mailing Address - Phone:918-453-5000
Mailing Address - Fax:918-458-6222
Practice Address - Street 1:471688 HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-4490
Practice Address - Country:US
Practice Address - Phone:918-696-8800
Practice Address - Fax:918-696-8840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK46-3911332800000X
332B00000X, 333600000X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100236190GMedicaid
2074919OtherPK
TEZ071Medicare PIN