| Organization Name: | USPHS/IHS/WEWOKA INDIAN HEALTH CLINIC |
| NPI Number: | 1073968855 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHANNON MICHELLE LOWE (ASSISTANT DIRECTOR OF PHARMACY) |
| Mailing Address: | 36640 Hwy 270 Wewoka |
| State: | OK US |
| Postal Code: | 748841475 |
| Phone Number: | 4052577361 |
| Fax Number: | 4052573344 |
| NPI Enumeration Date: | 04/28/2016 |
| NPI Last Update Date: | 04/28/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP0904X |
| License Number: | 14343 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Public Health, Federal |
| Taxonomy Definition: | |