CITIZEN POTAWATOMI NATION (NPI# 1881981744) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881981744 |
| Entity Type | Organization |
| Organization Name | CITIZEN POTAWATOMI NATION |
| Other Organization Name | CITIZEN POTAWATOMI NATION WEST CLINIC |
| Practice Address |
781 Grand Casino Blvd Shawnee OK 74804-1005 |
| Practice Telephone | 4059645770 |
| Practice Fax Number | 4059645785 |
| Mailing Telephone | 4059645770 |
| Mailing Fax Number | 4059645783 |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2014-10-01 |
| Authorized Official Name | MR. TIM TALL CHIEF (DIRECTOR OF HEALTH SERVICES) |
| Authorized Official Telephone | 4059645770 |
| Authorized Official Credential | M.ED. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100244300F | 05 | |
| OK | 100244300G | 05 | |
| OK | 100211300E | 05 |
| Other Name | Type Code |
|---|---|
| Citizen Potawatomi Nation West Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427659523 | Citizen Potawatomi Nation | Chiropractor | 204 E Walnut St, Tecumseh, OK 74873-2030 | 2020-11-04 |
| 1689680670 | Citizen Potawatomi Nation | Clinic/Center | 2307 S Gordon Cooper Dr, Shawnee, OK 74801-9007 | 2006-07-31 |
| 1194752949 | Citizen Potawatomi Nation | Clinic/Center | 2307 S Gordon Cooper Dr, Shawnee, OK 74801-9007 | 2006-06-27 |
| Street Address |
781 GRAND CASINO BLVD |
| City | SHAWNEE |
| State | OK |
| Zip Code | 74804-1005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285606608 | George A Vascellaro | Family Medicine | 781 Grand Casino Blvd, Shawnee, OK 74804-1005 | 2006-02-02 |
| 1871100255 | Rachel Louise Clark | Licensed Practical Nurse | 781 Grand Casino Blvd, Shawnee, OK 74804-1005 | 2020-09-29 |
| 1518593656 | Chantel Renne Andrews | Registered Nurse | 781 Grand Casino Blvd, Shawnee, OK 74804-1005 | 2020-03-20 |
| 1588209423 | Murphi E Sparkman | Physician Assistant | 781 Grand Casino Blvd, Shawnee, OK 74804-1005 | 2019-11-14 |
| 1427515568 | Markie Ryan Carlock | Licensed Practical Nurse | 781 Grand Casino Blvd, Shawnee, OK 74804-1005 | 2019-02-25 |
| 1790241370 | Lori Ishman | Licensed Practical Nurse | 781 Grand Casino Blvd, Shawnee, OK 74804-1005 | 2019-02-19 |
| 1063978757 | Nicole Brown | Licensed Practical Nurse | 781 Grand Casino Blvd, Shawnee, OK 74804-1005 | 2019-02-18 |
| 1093211732 | Jessica Williams | Licensed Practical Nurse | 781 Grand Casino Blvd, Shawnee, OK 74804-1005 | 2018-04-02 |
| 1376052795 | Jennifer Robertson | Licensed Practical Nurse | 781 Grand Casino Blvd, Shawnee, OK 74804 | 2017-09-28 |
| 1487011169 | Stephanie Ruby | Registered Nurse | 781 Grand Casino Blvd, Shawnee, OK 74804-1005 | 2016-01-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164063699 | Isaac Benjamin Gray | Student in an Organized Health Care Education/Training Program | 4010 Blaine Road, Shawnee, OK 74804 | 2019-10-06 |
| 1750863775 | Dillon Gibson | Specialist/Technologist | Oklahoma Baptist University, 500 W. University, Shawnee, OK 74804 | 2018-09-06 |
| 1912368242 | Peggy Baker | Occupational Therapist | 7602 N. Kickapoo, Shawnee, OK 74804 | 2016-03-15 |
| 1861731093 | Shariff Mohammed El-assi | Behavioral Analyst | 45 Crown Point, Shawnee, OK 74804 | 2013-02-07 |
| 1902103112 | Action Physical Therapy & Rehabilitation, Pllc | Physical Therapist | 2506 N Harrison, Shawnee, OK 74804 | 2011-02-24 |
| 1639493315 | Oklahoma Em - 1 Medical Services,p.c. | Emergency Medicine | 1102 W.macarthur, Shawnee, OK 74804 | 2010-03-24 |
| 1790989473 | Eastern Oklahoma Radiation Associates, LLC | Radiology | 3700 N Kickapoo Ave Ste 108, Shawnee, OK 74804 | 2007-06-14 |
| 1821210444 | Mickey Sehorn D.d.s., P.C. | Dentist | 1601 Airport Drive, Shawnee, OK 74804 | 2007-05-03 |
| 1760525711 | Leanna Rae Olsen | Registered Nurse | 1500 N. Kickapoo, Suite #4, Shawnee, OK 74804 | 2007-02-15 |
| 1467517920 | Mahmoud Abdel-fattah Khalifa | Pathology | Unity Health Center, 1102 West Macarthur, Shawnee, OK 74804 | 2006-12-26 |
| Find all providers in zip 74804 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851727754 | Community Health Centers, Inc. | Clinic/Center | 130 N Broadway, Suite 300, Shawnee, OK 74801-6939 | 2013-09-24 |
| 1194752949 | Citizen Potawatomi Nation | Clinic/Center | 2307 S Gordon Cooper Dr, Shawnee, OK 74801-9007 | 2006-06-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902404965 | Variety Care, Inc. | Clinic/Center | 201 Ne 50th St Ste 117, Oklahoma City, OK 73105-1811 | 2020-10-13 |
| 1699318550 | Community Health Center of Northeast Oklahoma, Inc. | Clinic/Center | 220 S Mickey Mantle Blvd, Commerce, OK 74339-2924 | 2019-10-23 |
| 1013567940 | Community Health Center of Southeast Kansas, Inc. | Clinic/Center | 7 S 1st St, Wyandotte, OK 74370-2268 | 2019-09-12 |
| 1013569961 | Community Health Connection, Inc. | Clinic/Center | 13702 E 46th Pl, Tulsa, OK 74134-5919 | 2019-07-11 |
| 1184286726 | Central Oklahoma Family Medical Center, Inc | Clinic/Center | 302 W Smith Street, Stratford, OK 74872-4648 | 2019-07-03 |
| 1982263752 | Shortgrass Community Health Center, Inc | Clinic/Center | 211 East Broadway, Altus, OK 73521 | 2019-06-06 |
| 1265902589 | Community Health Center of Northeast Oklahoma | Clinic/Center | 244 S Scraper Suite D, Vinita, OK 74301-3716 | 2018-11-29 |
| 1063988673 | Central Oklahoma Family Medical Center, Inc | Clinic/Center | 905 Colony Drive Bldg, Ada, OK 74820 | 2018-10-22 |
| 1306352547 | Variety Care, Inc. | Clinic/Center | 721 W Britton Rd, Oklahoma City, OK 73114-2909 | 2017-12-26 |
| 1568976991 | Arkansas Verdigris Valley Health Centers,inc. | Clinic/Center | 201 North 32nd Street, Muskogee, OK 74401-2104 | 2017-11-21 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.