Provider Demographics
NPI:1811540362
Name:PEORIA TRIBE OF INDIANS OF OKLAHOMA
Entity Type:Organization
Organization Name:PEORIA TRIBE OF INDIANS OF OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DEVELOPMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-540-2535
Mailing Address - Street 1:118 S EIGHT TRIBES TRL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-1002
Mailing Address - Country:US
Mailing Address - Phone:918-540-2535
Mailing Address - Fax:
Practice Address - Street 1:118 S EIGHT TRIBES TRL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-1002
Practice Address - Country:US
Practice Address - Phone:918-540-2535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health