NPIMap

Organization Active NPI

Kickapoo Tribal Health Center

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • McLoud, OK
National Provider Identifier
1194803346
Registry record updated Oct 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
Legal business name
KICKAPOO TRIBAL HEALTH CENTER
Practice address
105365 S. Hwy 102
Building M
McLoud, OK 74851
Phone
(405) 964-2081
Fax
(405) 964-7160
NPI assigned
Nov 2, 2006
Last updated
Oct 6, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Wayne Irion
Title
Health Director
Phone
(405) 964-2081

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X NU Primary

Addresses

Primary practice location

105365 S. Hwy 102
Building M
McLoud, OK 74851

Mailing address

105365 S. Hwy 102
Building M
McLoud, OK 74851
Phone (405) 964-2081

Other identifiers 2

IdentifierTypeStateIssuer
100245200AMedicaidOK
3721809OtherOKNABP

Other names 1

  • KICKAPOO TRIBAL PHARMACY Other name

National Provider Directory

National Provider Directory
Tax ID family
Kickapoo Tribal Health Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

105365 S Highway 102
Bldg M
McLoud, OK 74851
Phone (405) 964-2081

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759708800000",
    "number": "1194803346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105365 S. HWY 102",
            "address_2": "BUILDING M",
            "city": "MCLOUD",
            "state": "OK",
            "postal_code": "74851",
            "telephone_number": "405-964-2081",
            "fax_number": "405-964-7160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105365 S. HWY 102",
            "address_2": "BUILDING M",
            "city": "MCLOUD",
            "state": "OK",
            "postal_code": "74851",
            "telephone_number": "405-964-2081",
            "fax_number": "405-964-7160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KICKAPOO TRIBAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2025-10-06",
        "certification_date": "2025-10-06",
        "status": "A",
        "authorized_official_last_name": "IRION",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "HEALTH DIRECTOR",
        "authorized_official_telephone_number": "405-964-2081",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100245200A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "3721809",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KICKAPOO TRIBAL PHARMACY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in McLoud, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.