Provider Demographics
NPI:1518224260
Name:USPHS INDIAN HEALTH SERVICE
Entity Type:Organization
Organization Name:USPHS INDIAN HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLELLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MPA
Authorized Official - Phone:580-331-3314
Mailing Address - Street 1:10321 N 2274 RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-7521
Mailing Address - Country:US
Mailing Address - Phone:580-331-3300
Mailing Address - Fax:580-323-2579
Practice Address - Street 1:RR 1 BOX 34A
Practice Address - Street 2:
Practice Address - City:WATONGA
Practice Address - State:OK
Practice Address - Zip Code:73772-9706
Practice Address - Country:US
Practice Address - Phone:580-623-4991
Practice Address - Fax:580-623-5490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3568261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center