Organization
KICKAPOO TRIBAL HEALTH CENTER
Active
Organization
KICKAPOO TRIBAL HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WAYNE IRION (HEALTH DIRECTOR)
(405) 964-2081
Entity
Organization
Contact information
Practice address
105365 S. HWY 102, BUILDING M, MCLOUD, OK 74851
(405) 964-2081
(405) 964-2053
Mailing address
PO BOX 1360, MCLOUD, OK 74851-1360
(405) 964-2081
(405) 964-2053
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100700140A
—
OK
Enumeration date
10/31/2006
Last updated
10/06/2025
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