Provider Demographics
NPI:1821276445
Name:CREEK NATION HOSPITAL & CLINICS
Entity Type:Organization
Organization Name:CREEK NATION HOSPITAL & CLINICS
Other - Org Name:OKEMAH INDIAN HEALTH CENTER DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:AARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-756-4333
Mailing Address - Street 1:PO BOX 1312
Mailing Address - Street 2:FNB DEPT 001
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-1312
Mailing Address - Country:US
Mailing Address - Phone:918-756-4333
Mailing Address - Fax:918-756-3993
Practice Address - Street 1:309 N 14TH ST
Practice Address - Street 2:
Practice Address - City:OKEMAH
Practice Address - State:OK
Practice Address - Zip Code:74859-2028
Practice Address - Country:US
Practice Address - Phone:918-623-1424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREEK NATION HOSPITAL & CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-06
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100730400AMedicaid