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KICKAPOO TRIBAL HEALTH CENTER

Ambulatory Health Care Facilities Clinic/Center Dental

Provider NPI: 1265518203

Organization Information:
Organization Name:  KICKAPOO TRIBAL HEALTH CENTER
Organization is not Subpart
Authorized Official:  JANETTA  MAHTAPENE  HEALTH DIRECTOR  405-964-2081

Practice Location:
105365 S. HWY 102 BUILDING M MCLOUD, OK 74851 US
Tel: 405-964-2081  Fax: 405-964-2053

Business Mailing Address:
PO BOX 1360  MCLOUD, OK 74851-1360 US
Tel: 405-964-2081  Fax: 405-964-2053

NPI Information:
NPI: 1265518203
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N261QD0000XAmbulatory Health Care Facilities
Clinic/Center
Dental
N261QM0850XAmbulatory Health Care Facilities
Clinic/Center
N261QM0855XAmbulatory Health Care Facilities
Clinic/Center
N261QR0200XAmbulatory Health Care Facilities
Clinic/Center
N291U00000XLaboratories
Clinical Medical Laboratory
Y261QF0400XAmbulatory Health Care Facilities
Clinic/Center

Other Provider Identifiers:

IssuerNumberStateType
100700140AOK05



American Medical Association 2012 taxonomy code information

Code: 261QF0400X

Type:

Classification:



Definition:



MEDICAL JOBS OK - Page 1

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