NPIMap

Organization Active NPI

Citizen Potawatomi Nation West Clinic

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Shawnee, OK
National Provider Identifier
1598053993
Registry record updated May 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
License
105576 Issued in OK
Legal business name
CITIZEN POTAWATOMI NATION WEST CLINIC
Practice address
781 Grand Casino Blvd
Shawnee, OK 74804-1005
Phone
(405) 964-5770
Fax
(405) 964-5785
NPI assigned
Jul 19, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2026

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

Authorized official

Name
Aubry Bennett, CPC-A
Title
Business Office Coordinator
Phone
(405) 964-4025

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X 105576 OK Primary

Addresses

Primary practice location

781 Grand Casino Blvd
Shawnee, OK 74804-1005

Mailing address

781 Grand Casino Blvd
Shawnee, OK 74804-1005
Phone (405) 964-5770

Other identifiers 1

IdentifierTypeStateIssuer
100244300DMedicaidOK

National Provider Directory

National Provider Directory
Tax ID family
Tribal Affairs Citizen Band4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1311033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779062400000",
    "number": "1598053993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "781 GRAND CASINO BLVD",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748041005",
            "telephone_number": "405-964-5770",
            "fax_number": "405-964-5785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "781 GRAND CASINO BLVD",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748041005",
            "telephone_number": "405-964-5770",
            "fax_number": "405-964-5785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITIZEN POTAWATOMI NATION WEST CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-19",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "AUBRY",
        "authorized_official_title_or_position": "BUSINESS OFFICE COORDINATOR",
        "authorized_official_telephone_number": "405-964-4025",
        "authorized_official_credential": "CPC-A"
    },
    "taxonomies": [
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "OK",
            "license": "105576",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100244300D",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shawnee, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; 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.