Provider Demographics
NPI:1699118521
Name:CREEK NATION HEALTH
Entity type:Organization
Organization Name:CREEK NATION HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HIV EDUCATOR/STI/TESTER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FERRIS (HAWK)
Authorized Official - Last Name:COCKE'
Authorized Official - Suffix:
Authorized Official - Credentials:AA
Authorized Official - Phone:918-227-3800
Mailing Address - Street 1:1943 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-6532
Mailing Address - Country:US
Mailing Address - Phone:918-227-3800
Mailing Address - Fax:918-224-9309
Practice Address - Street 1:1943 SOUTH WATER
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066
Practice Address - Country:US
Practice Address - Phone:918-227-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty