Citizen Potawatomi Nation West Clinic

LBN: Citizen Potawatomi Nation West Clinic
Citizen Potawatomi Nation West Clinic is an health care organization with primary practice located at 781 Grand Casino Blvd , Shawnee OK 74804-1005. The organization recently has only one registered license in Suppliers / Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy, which is considered as the primary health care specialty. Citizen Potawatomi Nation West Clinic can be contacted via phone (405) 964-5770, or through Fortney, Doyle via phone (405) 964-5770.

Contact Information

Primary practice address
781 Grand Casino Blvd Shawnee OK 74804-1005
Phone: (405) 964-5770
Fax: (405) 964-5785
Website:
Map and Directions
Authorized official contact:
Name: Fortney, Doyle
Phone: (405) 964-5770

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X 105576 Oklahoma

Profile Details

NPI number 1598053993
LBN Legal business name Citizen Potawatomi Nation West Clinic
DBA Doing business as
Authorized official Fortney, Doyle
Entity Organization
Organization subpart 1 No
Enumeration date Jul 19th, 2011
Last updated Nov 16th, 2012 - about 12 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598053993 NPPES
Oklahoma MEDICAID 100244300D

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