CITIZEN POTAWATOMI NATION WEST CLINIC (NPI# 1598053993) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598053993 |
| Entity Type | Organization |
| Organization Name | CITIZEN POTAWATOMI NATION WEST CLINIC |
| Practice Address |
781 Grand Casino Blvd Shawnee OK 74804-1005 |
| Practice Telephone | 4059645770 |
| Practice Fax Number | 4059645785 |
| Mailing Telephone | 4059645770 |
| Mailing Fax Number | 4059645785 |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2012-11-16 |
| Authorized Official Name | DR. DOYLE FORTNEY (WEST CLINIC MANAGER) |
| Authorized Official Telephone | 4059645770 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 105576 | OK | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100244300D | 05 |
| Street Address |
781 GRAND CASINO BLVD |
| City | SHAWNEE |
| State | OK |
| Zip Code | 74804-1005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285606608 | George A Vascellaro | Family Medicine | 781 Grand Casino Blvd, Shawnee, OK 74804-1005 | 2006-02-02 |
| 1871100255 | Rachel Louise Clark | Licensed Practical Nurse | 781 Grand Casino Blvd, Shawnee, OK 74804-1005 | 2020-09-29 |
| 1518593656 | Chantel Renne Andrews | Registered Nurse | 781 Grand Casino Blvd, Shawnee, OK 74804-1005 | 2020-03-20 |
| 1588209423 | Murphi E Sparkman | Physician Assistant | 781 Grand Casino Blvd, Shawnee, OK 74804-1005 | 2019-11-14 |
| 1427515568 | Markie Ryan Carlock | Licensed Practical Nurse | 781 Grand Casino Blvd, Shawnee, OK 74804-1005 | 2019-02-25 |
| 1790241370 | Lori Ishman | Licensed Practical Nurse | 781 Grand Casino Blvd, Shawnee, OK 74804-1005 | 2019-02-19 |
| 1063978757 | Nicole Brown | Licensed Practical Nurse | 781 Grand Casino Blvd, Shawnee, OK 74804-1005 | 2019-02-18 |
| 1093211732 | Jessica Williams | Licensed Practical Nurse | 781 Grand Casino Blvd, Shawnee, OK 74804-1005 | 2018-04-02 |
| 1376052795 | Jennifer Robertson | Licensed Practical Nurse | 781 Grand Casino Blvd, Shawnee, OK 74804 | 2017-09-28 |
| 1487011169 | Stephanie Ruby | Registered Nurse | 781 Grand Casino Blvd, Shawnee, OK 74804-1005 | 2016-01-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164063699 | Isaac Benjamin Gray | Student in an Organized Health Care Education/Training Program | 4010 Blaine Road, Shawnee, OK 74804 | 2019-10-06 |
| 1750863775 | Dillon Gibson | Specialist/Technologist | Oklahoma Baptist University, 500 W. University, Shawnee, OK 74804 | 2018-09-06 |
| 1912368242 | Peggy Baker | Occupational Therapist | 7602 N. Kickapoo, Shawnee, OK 74804 | 2016-03-15 |
| 1861731093 | Shariff Mohammed El-assi | Behavioral Analyst | 45 Crown Point, Shawnee, OK 74804 | 2013-02-07 |
| 1902103112 | Action Physical Therapy & Rehabilitation, Pllc | Physical Therapist | 2506 N Harrison, Shawnee, OK 74804 | 2011-02-24 |
| 1639493315 | Oklahoma Em - 1 Medical Services,p.c. | Emergency Medicine | 1102 W.macarthur, Shawnee, OK 74804 | 2010-03-24 |
| 1790989473 | Eastern Oklahoma Radiation Associates, LLC | Radiology | 3700 N Kickapoo Ave Ste 108, Shawnee, OK 74804 | 2007-06-14 |
| 1821210444 | Mickey Sehorn D.d.s., P.C. | Dentist | 1601 Airport Drive, Shawnee, OK 74804 | 2007-05-03 |
| 1760525711 | Leanna Rae Olsen | Registered Nurse | 1500 N. Kickapoo, Suite #4, Shawnee, OK 74804 | 2007-02-15 |
| 1467517920 | Mahmoud Abdel-fattah Khalifa | Pathology | Unity Health Center, 1102 West Macarthur, Shawnee, OK 74804 | 2006-12-26 |
| Find all providers in zip 74804 | ||||
| Taxonomy Code | 332800000X |
| Grouping | Suppliers |
| Classification | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
| An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603. |
| Notes: Source: The Medicare Prescription Drug, Improvement and Modernization Act of 2003 [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831294024 | Absentee Shawnee Tribal Health Authority | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 2029 S Gordon Cooper Drive, Shawnee, OK 74801 | 2006-09-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639472970 | Carnegie Indian Health Clinic | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 212 E. 4th St, Carnegie, OK 73015 | 2010-12-08 |
| 1568512374 | Wewoka Ihs Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | Intersection of Hwy 56 and 270, Wewoka, OK 74884 | 2007-01-12 |
| 1316097389 | Anadarko Ihs Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 115 Ne Old Town Rd, Anadarko, OK 73005-5009 | 2007-01-11 |
| 1538219431 | El Reno Ihs Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1801 Parkview Drive, El Reno, OK 73632 | 2007-01-11 |
| 1871663203 | Sac & Fox Nation | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 356110 E 930 Rd, Stroud, OK 74079-5184 | 2006-11-09 |
| 1699790543 | Li-si-wi-nwi Health, Inc | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 15951 Little Axe Drive, Norman, OK 73026-9001 | 2006-07-13 |
| 1952303190 | Pawhuska Ihs Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 715 Grandview Ave, Pawhuska, OK 74056-3201 | 2005-06-01 |
| 1568839470 | Osage Nation | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 715 Grandview Ave, Pawhuska, OK 74056-3201 | 2015-08-26 |
| 1295142115 | Choctaw Nation of Oklahoma | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1801 Chukka Hina, Durant, OK 74701 | 2014-07-14 |
| 1891999157 | White Eagle Health Center | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 200 White Eagle Drive, Ponca City, OK 74601 | 2007-06-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.