Provider Demographics
NPI:1780841734
Name:CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL, INC.
Entity Type:Organization
Organization Name:CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL, INC.
Other - Org Name:OKLAHOMA CITY INDIAN CLINIC LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SUNDAY-ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RN
Authorized Official - Phone:405-948-4900
Mailing Address - Street 1:4913 W RENO AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-6339
Mailing Address - Country:US
Mailing Address - Phone:405-948-4900
Mailing Address - Fax:405-948-4936
Practice Address - Street 1:4913 W RENO AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-6339
Practice Address - Country:US
Practice Address - Phone:405-948-4900
Practice Address - Fax:405-948-4936
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-19
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
37D0663081OtherCLIA
37D2025076OtherCLIA
OK100731010AMedicaid
371818OtherMEDICARE