Provider Demographics
NPI:1619241502
Name:MUSCOGEE CREEK NATION
Entity Type:Organization
Organization Name:MUSCOGEE CREEK NATION
Other - Org Name:CREEK NATION HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACTING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-756-3334
Mailing Address - Street 1:1125 E CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-4641
Mailing Address - Country:US
Mailing Address - Phone:918-224-9310
Mailing Address - Fax:918-224-6659
Practice Address - Street 1:9 N WATER ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-2819
Practice Address - Country:US
Practice Address - Phone:918-224-9307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management