| Organization Name: | OSAGE NATION |
| NPI Number: | 1902272826 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MANON DANETTE TILLMAN (HEALTH & WELLNESS DIVISION LEADER) |
| Mailing Address: | 715 Grandview Ave Pawhuska |
| State: | OK US |
| Postal Code: | 740563201 |
| Phone Number: | 9182874491 |
| Fax Number: | 9182875251 |
| NPI Enumeration Date: | 08/14/2015 |
| NPI Last Update Date: | 08/14/2015 |
| 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: | |