Provider Demographics
NPI:1821636358
Name:MODOC NATION BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:MODOC NATION BEHAVIORAL HEALTH
Other - Org Name:MODOC NATION BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-533-7903
Mailing Address - Street 1:22 N EIGHT TRIBES TRL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-1011
Mailing Address - Country:US
Mailing Address - Phone:918-387-8720
Mailing Address - Fax:918-238-4225
Practice Address - Street 1:21 N EIGHT TRIBES TRL STE B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-1010
Practice Address - Country:US
Practice Address - Phone:918-387-8720
Practice Address - Fax:918-238-4225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKSKOK0Medicaid