Organization
CITIZEN POTAWATOMI NATION WEST CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUBRY BENNETT CPC-A (BUSINESS OFFICE COORDINATOR)
(405) 964-4025
Entity
Organization
Contact information
Practice address
781 GRAND CASINO BLVD, SHAWNEE, OK 74804-1005
(405) 964-5770
(405) 964-5785
Mailing address
781 GRAND CASINO BLVD, SHAWNEE, OK 74804-1005
(405) 964-5770
(405) 964-5785
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
105576
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100244300D
—
OK
Enumeration date
07/19/2011
Last updated
05/18/2026
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