Organization Name: | SAC & FOX NATION |
NPI Number: | 1083821011 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LEDORA MCDOUGLE (HEALTH DIRECTOR) |
Mailing Address: | Rr 2 Box 247 Stroud |
State: | OK US |
Postal Code: | 740799652 |
Phone Number: | 9189689531 |
Fax Number: | 9189680113 |
NPI Enumeration Date: | 05/17/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | R0069265 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |