Provider Demographics
NPI:1629886783
Name:OTOE-MISSOURIA TRIBE
Entity type:Organization
Organization Name:OTOE-MISSOURIA TRIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LINCOLN
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:580-723-4466
Mailing Address - Street 1:8151 HIGHWAY 177
Mailing Address - Street 2:
Mailing Address - City:RED ROCK
Mailing Address - State:OK
Mailing Address - Zip Code:74651-0348
Mailing Address - Country:US
Mailing Address - Phone:580-723-4466
Mailing Address - Fax:
Practice Address - Street 1:8151 HIGHWAY 177
Practice Address - Street 2:
Practice Address - City:RED ROCK
Practice Address - State:OK
Practice Address - Zip Code:74651-0348
Practice Address - Country:US
Practice Address - Phone:580-723-4466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center