KICKAPOO TRIBAL HEALTH CENTER; NPI #1265518203

Contact Information

KICKAPOO TRIBAL HEALTH CENTER

105365 S. HWY 102
BUILDING M
MCLOUD, OK 74851

Phone: 405-964-2081
Fax: 405-964-2053
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Federally Qualified Health Center (FQHC)	261QF0400X	B4[14]	Federally Qualified Health Center
Adolescent and Children Mental Health	261QM0855X
Adult Mental Health	261QM0850X
Clinical Medical Laboratory	291U00000X	69	Clinical Laboratory
Dental	261QD0000X
Radiology	261QR0200X	74	Radiation Therapy Center

Indicates primary specialty

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NPI Profile & details for KICKAPOO TRIBAL HEALTH CENTER

NPI Number 1265518203

LBN Legal business name KICKAPOO TRIBAL HEALTH CENTER

Authorized official WAYNE IRION - (HEALTH DIRECTOR)

Entity Organization

Organization subpart ¹ No

Enumeration date 10/31/2006

Last updated 10/06/2025 - About 8 months ago

Identifiers

Medicaid

100700140A

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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