United Keetoowah Band Community Health Initiative, LLC

Primary specialty

Point of ServiceTaxonomy code 305S00000X

License

OK4140 Issued in OK

Legal business name

UNITED KEETOOWAH BAND COMMUNITY HEALTH INITIATIVE, LLC

Practice address

2450 S Muskogee Ave
Tahlequah, OK 74464-5450

Phone

(918) 431-1818

Fax

(918) 431-1873

NPI assigned

Sep 11, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Bryan Clark Shade, MBA

Title

Executive Director

Phone

(918) 431-1818

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1347321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347321600000",
    "number": "1962752659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 S MUSKOGEE AVE",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744645450",
            "telephone_number": "918-431-1818",
            "fax_number": "918-431-1873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 S MUSKOGEE AVE",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744645450",
            "telephone_number": "918-431-1818",
            "fax_number": "918-431-1873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNITED KEETOOWAH BAND COMMUNITY HEALTH INITIATIVE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-11",
        "last_updated": "2012-09-11",
        "status": "A",
        "authorized_official_last_name": "SHADE",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "CLARK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "918-431-1818",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "OK",
            "license": "OK4140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Mattocks Turner, BHRS
• Victoria Tye
• Kimberly Tyer
• Megan Underwood, PHARMD
• Adrian Unger, APRN
• United Keetoowah Band of Cherokee Indians
• University Northwest, LLC (Grace Living Center - University NW)
• Jameel Ameer Uqdah, M.D.
• Drake Uriguen
• Jessica Ranee Uriguen

• Point of Service in Tahlequah, OK
• Providers in Tahlequah, OK by specialty
• Point of Service in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2012; 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.