Provider Demographics
NPI:1902344328
Name:DEPT OF HEALTH AND HUMAN SERVICES PHS INDIAN HEALTH SERVICE
Entity Type:Organization
Organization Name:DEPT OF HEALTH AND HUMAN SERVICES PHS INDIAN HEALTH SERVICE
Other - Org Name:OCAO INDIAN HEALTH SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-615-8971
Mailing Address - Street 1:701 MARKET DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-8132
Mailing Address - Country:US
Mailing Address - Phone:405-951-3815
Mailing Address - Fax:405-951-3916
Practice Address - Street 1:701 MARKET DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-8132
Practice Address - Country:US
Practice Address - Phone:405-951-3815
Practice Address - Fax:405-951-3916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization