| Organization Name: | KICKAPOO TRIBAL HEALTH CENTER |
| NPI Number: | 1265518203 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JANETTA MAHTAPENE (HEALTH DIRECTOR) |
| Mailing Address: | 105365 S. Hwy 102 Building M Mcloud |
| State: | OK US |
| Postal Code: | 74851 |
| Phone Number: | 4059642081 |
| Fax Number: | 4059642053 |
| NPI Enumeration Date: | 10/31/2006 |
| NPI Last Update Date: | 11/02/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |