Provider Demographics
NPI:1487076519
Name:CREEK NATION HOSPITAL & CLINICS
Entity type:Organization
Organization Name:CREEK NATION HOSPITAL & CLINICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY OF HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:SENECA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-756-4333
Mailing Address - Street 1:MUSCOGEE CREEK NATION DIALYSIS KOWETA
Mailing Address - Street 2:DEPT 2130
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74182-0001
Mailing Address - Country:US
Mailing Address - Phone:918-756-4333
Mailing Address - Fax:
Practice Address - Street 1:31870 E STATE HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429-7900
Practice Address - Country:US
Practice Address - Phone:918-279-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment