Provider Demographics
NPI:1205923448
Name:CLINTON INDIAN HEALTH CENTER
Entity type:Organization
Organization Name:CLINTON INDIAN HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AREA DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-331-3315
Mailing Address - Street 1:RR 1 BOX 3060
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-9303
Mailing Address - Country:US
Mailing Address - Phone:580-331-3404
Mailing Address - Fax:580-331-3565
Practice Address - Street 1:10321 N 2274 RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-7521
Practice Address - Country:US
Practice Address - Phone:580-331-3404
Practice Address - Fax:580-331-3565
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAWTON INDIAN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-09
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200119820AMedicaid
OK370170Medicare PIN
OKHSZ015Medicare PIN