Provider Demographics
NPI:1811980154
Name:CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL, INC.
Entity type:Organization
Organization Name:CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SUNDAY-ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MPH
Authorized Official - Phone:405-948-4900
Mailing Address - Street 1:4913 W RENO AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-6339
Mailing Address - Country:US
Mailing Address - Phone:405-948-4900
Mailing Address - Fax:405-948-4929
Practice Address - Street 1:4913 W RENO AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-6339
Practice Address - Country:US
Practice Address - Phone:405-948-4900
Practice Address - Fax:405-948-4929
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL OKLAHOMA AMERICAN INDIAN HEALTH COUNCIL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-23
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332800000X
OK14183333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100243180AMedicaid