| Citizen Potawatomi Nation West Clinic | |
|
781 Grand Casino Blvd Shawnee OK 74804-1005 | |
| (405) 964-5770 | |
| (405) 964-5785 |
| Full Name | Citizen Potawatomi Nation West Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 781 Grand Casino Blvd, Shawnee, Oklahoma |
| Authorized Official Name and Position | Tim Tall Chief (DIRECTOR OF HEALTH SERVICES) |
| Authorized Official Contact | 4059645770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Citizen Potawatomi Nation West Clinic 781 Grand Casino Blvd Shawnee OK 74804-1005 Ph: (405) 964-5770 | Citizen Potawatomi Nation West Clinic 781 Grand Casino Blvd Shawnee OK 74804-1005 Ph: (405) 964-5770 |
| NPI Number | 1881981744 |
|---|---|
| Provider Enumeration Date | 06/29/2011 |
| Last Update Date | 10/01/2014 |
| Medicare PECOS PAC ID | 3375511488 |
|---|---|
| Medicare Enrollment ID | O20120105000559 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881981744 | NPI | - | NPPES |
| 100244300F | Medicaid | OK | |
| 100244300G | Medicaid | OK | |
| 100211300E | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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