Provider Demographics
NPI:1104872456
Name:IOWA TRIBE OF OKLAHOMA
Entity type:Organization
Organization Name:IOWA TRIBE OF OKLAHOMA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TRIBAL ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TOD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-547-2402
Mailing Address - Street 1:RR 1 BOX 721
Mailing Address - Street 2:
Mailing Address - City:PERKINS
Mailing Address - State:OK
Mailing Address - Zip Code:74059
Mailing Address - Country:US
Mailing Address - Phone:405-547-2473
Mailing Address - Fax:405-547-2925
Practice Address - Street 1:501 E HIGHWAY 33
Practice Address - Street 2:
Practice Address - City:PERKINS
Practice Address - State:OK
Practice Address - Zip Code:74059
Practice Address - Country:US
Practice Address - Phone:405-547-2473
Practice Address - Fax:405-547-2925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center