Provider Demographics
NPI:1871646778
Name:CREEK NATION HOSPITAL AND CLINICS
Entity Type:Organization
Organization Name:CREEK NATION HOSPITAL AND CLINICS
Other - Org Name:CNCH SPECIALTY CLINICS
Other - Org Type:Other Name
Authorized Official - Title/Position:SECRETARY OF HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-756-3334
Mailing Address - Street 1:DEPT 1038
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74182-0001
Mailing Address - Country:US
Mailing Address - Phone:918-756-4333
Mailing Address - Fax:918-756-3993
Practice Address - Street 1:1800 E COPLIN ST
Practice Address - Street 2:
Practice Address - City:OKEMAH
Practice Address - State:OK
Practice Address - Zip Code:74859-4642
Practice Address - Country:US
Practice Address - Phone:918-623-1424
Practice Address - Fax:918-623-3015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREEK NATION HOSPITAL AND CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-22
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100699980DMedicaid