UNITED KEETOOWAH BAND COMMUNITY HEALTH INITIATIVE, LLC (NPI# 1962752659) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962752659 |
| Entity Type | Organization |
| Organization Name | UNITED KEETOOWAH BAND COMMUNITY HEALTH INITIATIVE, LLC |
| Practice Address |
2450 S Muskogee Ave Tahlequah OK 74464-5450 |
| Practice Telephone | 9184311818 |
| Practice Fax Number | 9184311873 |
| Mailing Telephone | 9184311818 |
| Mailing Fax Number | 9184311873 |
| Enumeration Date | 2012-09-11 |
| Last Update Date | 2012-09-11 |
| Authorized Official Name | MR. BRYAN CLARK SHADE (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 9184311818 |
| Authorized Official Credential | MBA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 305S00000X | Point of Service | OK4140 | OK | Managed Care Organizations |
| Street Address |
2450 S MUSKOGEE AVE |
| City | TAHLEQUAH |
| State | OK |
| Zip Code | 74464-5450 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184253403 | Kendall Harris | Student in an Organized Health Care Education/Training Program | 100 Bliss Ave, Tahlequah, OK 74464 | 2020-04-07 |
| 1528609302 | Norma Brightly | Technician | 103 Sequoyah, Tahlequah, OK 74464 | 2019-10-03 |
| 1073175832 | Jody Lynn Dallis | Case Manager/Care Coordinator | Tenkiller Behavioral Services, 27753 S. Welling Rd, Welling, OK 74464 | 2019-07-02 |
| 1184287849 | Perry Jake Proctor | Student in an Organized Health Care Education/Training Program | 1400 E Downing St, Tahlequah, Ok 74464, Tahlequah, OK 74464 | 2019-04-18 |
| 1336657279 | Sidney Sheyenne Kimble | Case Manager/Care Coordinator | 1429 Jack Brown Lane, Tahlequah, OK 74464 | 2018-01-12 |
| 1891225686 | Nichols Bradley Alberty | Orthotist | 1294 East Downing, Suite 3, Tahlequah, OK 74464 | 2017-06-14 |
| 1922549690 | Krystal Easter Ms, Lpc | Counselor | 2201 Oakridge Dr, Tahlequah, OK 74464 | 2017-03-15 |
| 1144777319 | Northeastern Oklahoma Community Health Centers, Inc. | Clinic/Center | 529 N. Oak St., Tahlequah, OK 74464 | 2016-09-06 |
| 1548713456 | Clement Isioma Nwadozi | Optometrist | 3763 Southridge Cir Apt 6, Tahlequah, OK 74464 | 2016-07-27 |
| 1033532635 | Wesley Gragg | Specialist/Technologist | 603 North Grand Avenue, Tahlequah, OK 74464 | 2014-02-03 |
| Find all providers in zip 74464 | ||||
| Taxonomy Code | 305S00000X |
| Grouping | Managed Care Organizations |
| Classification | Point of Service |
| This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 62 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184079014 | Raphael Bonelle | Point of Service | 12201 Garden Ct, Oklahoma City, OK 73170-4006 | 2016-04-28 |
| 1972988707 | Sandra Taylor | Point of Service | 906 W 9th Pl. South, Claremore, OK 74017-0000 | 2015-07-22 |
| 1639565153 | Ryian Reyes | Point of Service | 2101 N 14th, Suite 134, Ponca City, OK 74601 | 2015-04-10 |
| 1619374337 | His Arms Extended | Point of Service | 2358 County Road 1325, Blanchard, OK 73010-3522 | 2014-11-24 |
| 1114265576 | National Practitioners Services LLC | Point of Service | 5515 E 76th St, Tulsa, OK 74136-8429 | 2013-01-19 |
| 1649547001 | Javersak Family Chiropractic | Point of Service | 1005 Shady Holw, 1005 Shady Hollow Ct, Mcalester, OK 74501-8342 | 2011-11-29 |
| 1588984553 | Mental Health Recovery | Point of Service | 2201 Nw 122nd St Apt 513, Oklahoma City, OK 73120-8405 | 2010-06-01 |
| 1144466962 | Lifeback Chiropractic Plc | Point of Service | 1101 N Harrison St Ste B, Shawnee, OK 74801-5205 | 2008-12-29 |
| 1780858654 | J.michael Wyatt Inc.p.c. | Point of Service | 736 Nw 63rd St, Oklahoma City, OK 73116-7602 | 2008-04-22 |
| 1710186994 | Lase Med, Inc. | Point of Service | 500 N Poplar Ave, Ste A, Broken Arrow, OK 74012-2337 | 2007-07-17 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on UNITED KEETOOWAH BAND COMMUNITY HEALTH INITIATIVE, LLC.
| 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.