Active NPI
Wyandotte Nation
- Family Medicine Physician
- Wyandotte, OK
National Provider Identifier
1124185517
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- WYANDOTTE NATION
- Practice address
- 1 Turtle Drive
Wyandotte, OK 74370 - Phone
- (918) 678-2282
- Fax
- (918) 678-2759
- NPI assigned
- Jan 3, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Kelly Friend
- Title
- Health Director
- Phone
- (918) 678-2282
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary | ||
| Clinic/Center | 261Q00000X |
Addresses
Primary practice location
1 Turtle Drive
Wyandotte, OK 74370
Mailing address
1 Turtle Drive
Wyandotte, OK 74370
Phone (918) 678-2282
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100707880A | Medicaid | OK | |
| 100732740B | Medicaid | OK |
Other names 1
- Bearskin Health Clinic
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150923000516 | TX | Part B Supplier - Mass Immunization (Roster Biller Only) | 6406748367 | Practice locations: Wyandotte, OK |
| O20250604003182 | TX | Part B Supplier - Clinic/Group Practice | 6406748367 |
Receives reassigned benefits from 11 practitioners Practice locations: Wyandotte, OK |
National Provider Directory
National Provider DirectoryLocations
1 Turtle Dr
Wyandotte, OK 74370
Phone (918) 678-2282
Practitioners & affiliated clinicians
Practitioners 11
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Fayetteville, AR
- NPI 1104866029
Family Medicine, TX
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1662422400000",
"number": "1124185517",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 TURTLE DRIVE",
"city": "WYANDOTTE",
"state": "OK",
"postal_code": "74370",
"telephone_number": "918-678-2282",
"fax_number": "918-678-2759"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 TURTLE DRIVE",
"city": "WYANDOTTE",
"state": "OK",
"postal_code": "74370",
"telephone_number": "918-678-2282",
"fax_number": "918-678-2759"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WYANDOTTE NATION",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-03",
"last_updated": "2022-09-06",
"certification_date": "2022-09-06",
"status": "A",
"authorized_official_last_name": "FRIEND",
"authorized_official_first_name": "KELLY",
"authorized_official_title_or_position": "HEALTH DIRECTOR",
"authorized_official_telephone_number": "918-678-2282",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100707880A",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100732740B",
"state": "OK"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Bearskin Health Clinic",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Bearskin Health Clinic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Wyandotte, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.