KICKAPOO TRIBAL HEALTH CENTER NPI 1265518203

NPI Information

NPI: 1265518203
Provider Name: KICKAPOO TRIBAL HEALTH CENTER
Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 37D2077917

Address:
105365 S. HWY 102
BUILDING M
MCLOUD, OK
ZIP 74851
Phone: (405) 964-2081
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KICKAPOO TRIBAL HEALTH CENTER is a federally qualified health center (fqhc) clinic center in Mcloud, OK. KICKAPOO TRIBAL HEALTH CENTER NPI is 1265518203. The provider is registered as an organization entity type.

The provider's business location address is:

105365 S. HWY 102
BUILDING M
MCLOUD, OK
ZIP 74851
Phone: (405) 964-2081
Fax: (405) 964-2053

The provider's authorized official is Janetta Mahtapene .
The authorized official title is Health Director and has the following contact phone number (405) 964-2081.

The CLIA number assigned to this NPI record is 37D2077917 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/31/2006 and was last updated on 11/2/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	261QD0000X	Clinic/Center	Dental	No
2	261QM0850X	Clinic/Center	Adult Mental Health	No
3	261QM0855X	Clinic/Center	Adolescent and Children Mental Health	No
4	261QR0200X	Clinic/Center	Radiology	No
5	291U00000X	Clinical Medical Laboratory		No
6	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100700140A	MEDICAID	OKLAHOMA
2	371826	MEDICARE OSCAR/CERTIFICATION	WISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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