Provider Demographics
NPI:1700977808
Name:DHHS US PUBLIC HEALTH SERVICE INDIAN HEALTH SERVICE
Entity Type:Organization
Organization Name:DHHS US PUBLIC HEALTH SERVICE INDIAN HEALTH SERVICE
Other - Org Name:PAWHUSKA INDIAN HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:EDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:918-287-4491
Mailing Address - Street 1:715 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PAWHUSKA
Mailing Address - State:OK
Mailing Address - Zip Code:74056
Mailing Address - Country:US
Mailing Address - Phone:918-287-4491
Mailing Address - Fax:918-287-2347
Practice Address - Street 1:101S MOORE AVE
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-5047
Practice Address - Country:US
Practice Address - Phone:918-287-4491
Practice Address - Fax:918-287-2347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100689200DMedicaid
OK100700620NOtherMEDICAID CAP
OK100231960FOtherMEDICAID RX
OKHSZ007Medicare PIN
OK100689200DMedicaid
OK370173Medicare Oscar/Certification