Provider Demographics
NPI:1891999157
Name:WHITE EAGLE HEALTH CENTER
Entity Type:Organization
Organization Name:WHITE EAGLE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:L
Authorized Official - Last Name:LITTLECOOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-765-2501
Mailing Address - Street 1:200 WHITE EAGLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601
Mailing Address - Country:US
Mailing Address - Phone:580-765-2501
Mailing Address - Fax:580-765-0984
Practice Address - Street 1:200 WHITE EAGLE DRIVE
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601
Practice Address - Country:US
Practice Address - Phone:580-765-2501
Practice Address - Fax:580-765-0984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3722938OtherNCPDP NUMBER
OK100700590BMedicaid
BW7072983OtherPHARMACY DEA NUMBER
400522110Medicare PIN