Provider Demographics
NPI:1578708475
Name:DEPT OF HEALTH AND HUMAN SERVICES PHS INDIAN HEALTH SERVICE
Entity Type:Organization
Organization Name:DEPT OF HEALTH AND HUMAN SERVICES PHS INDIAN HEALTH SERVICE
Other - Org Name:OCAO CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AREA DIRECTOR/ACTING
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:405-931-3829
Mailing Address - Street 1:701 MARKET DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-8132
Mailing Address - Country:US
Mailing Address - Phone:405-951-3820
Mailing Address - Fax:405-951-3780
Practice Address - Street 1:701 MARKET DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-8132
Practice Address - Country:US
Practice Address - Phone:405-951-3820
Practice Address - Fax:405-951-3780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)