DHHS US Public Health Service Indian Health Service

Primary specialty

Federal Public Health Clinic/CenterTaxonomy code 261QP0904X

Legal business name

DHHS US PUBLIC HEALTH SERVICE INDIAN HEALTH SERVICE

Doing business as

Pawhuska Indian Health Center

Practice address

101S Moore Ave
Claremore, OK 74017-5047

Phone

(918) 287-4491

Fax

(918) 287-2347

NPI assigned

Sep 27, 2006

Last updated

Aug 31, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Amy D Eden, MPH

Title

Business Office Manager

Phone

(918) 287-4491

Specialties & licenses 1

Addresses

Other names 1

• Pawhuska Indian Health Center Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700977808. Details of each certification follow.

• CCN 37020F Hospital · Active · Name & address match · Details

Hospital certification: CCN 37020F

Legal name

US PUBLIC HEALTH SERVICE INDIAN HOSP

Certification status

Active

Provider type (POS)

Hospital

Participating since

Mar 1, 1991

Last certification

Mar 1, 1991

Beds

66

Facility address

101 South Moore Ave
Claremore, OK 74017

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251676800000",
    "number": "1700977808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 GRANDVIEW AVE",
            "city": "PAWHUSKA",
            "state": "OK",
            "postal_code": "74056",
            "telephone_number": "918-287-4491",
            "fax_number": "918-287-2347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101S MOORE AVE",
            "city": "CLAREMORE",
            "state": "OK",
            "postal_code": "740175047",
            "telephone_number": "918-287-4491",
            "fax_number": "918-287-2347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DHHS US PUBLIC HEALTH SERVICE INDIAN HEALTH SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2009-08-31",
        "status": "A",
        "authorized_official_last_name": "EDEN",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "918-287-4491",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "261QP0904X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, Federal",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pawhuska Indian Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Depoe
• Seth Palmer Destefano
• Brook Colburn Detrick, LMT, CMLDT
• Elizabeth Devary, LPC
• Leah Michelle Dewhitt
• Linsey Dickerson
• Jennifer Deleen Dill
• Lanie Denae Dipley, COTA
• Lynnette Dixon
• Randye N Dixon, PT-DPT

• Clinic/Center in Claremore, OK
• Providers in Claremore, OK by specialty
• Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.