Provider Demographics
NPI:1942098470
Name:INDIAN HEALTH CARE RESOURCE CENTER OF TULSA, INC.
Entity type:Organization
Organization Name:INDIAN HEALTH CARE RESOURCE CENTER OF TULSA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-588-1900
Mailing Address - Street 1:530 S PEORIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120
Mailing Address - Country:US
Mailing Address - Phone:918-588-1900
Mailing Address - Fax:918-582-8552
Practice Address - Street 1:530 S PEORIA AVENUE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120
Practice Address - Country:US
Practice Address - Phone:918-588-1900
Practice Address - Fax:918-582-8552
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIAN HEALTH CARE RESOURCE CENTER OF TULSA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1457447609Medicaid
OK1427034958Medicaid