Provider Demographics
NPI:1023049350
Name:CREEK NATION HOSPITAL AND CLINICS
Entity type:Organization
Organization Name:CREEK NATION HOSPITAL AND CLINICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:918-756-4333
Mailing Address - Street 1:DEPT 1467
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:918-756-3334
Mailing Address - Fax:918-756-3993
Practice Address - Street 1:1313 E 20TH
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447
Practice Address - Country:US
Practice Address - Phone:918-756-0206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREEK NATION HOSPITAL AND CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-05
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK730932018009OtherBLUE CROSS BLUE SHIELD
OK100700620FMedicaid