Provider Demographics
NPI:1487752465
Name:KAW NATION
Entity type:Organization
Organization Name:KAW NATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-362-1039
Mailing Address - Street 1:PO BOX 474
Mailing Address - Street 2:3151 E. RIVER ROAD
Mailing Address - City:NEWKIRK
Mailing Address - State:OK
Mailing Address - Zip Code:74647-0474
Mailing Address - Country:US
Mailing Address - Phone:580-362-1039
Mailing Address - Fax:580-362-2988
Practice Address - Street 1:3151 E. RIVER ROAD
Practice Address - Street 2:
Practice Address - City:NEWKIRK
Practice Address - State:OK
Practice Address - Zip Code:74647
Practice Address - Country:US
Practice Address - Phone:580-362-1039
Practice Address - Fax:580-362-2988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100809950BMedicaid