Provider Demographics
NPI:1881981744
Name:CITIZEN POTAWATOMI NATION
Entity type:Organization
Organization Name:CITIZEN POTAWATOMI NATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SKILLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-964-5770
Mailing Address - Street 1:781 GRAND CASINO BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1005
Mailing Address - Country:US
Mailing Address - Phone:405-964-5770
Mailing Address - Fax:405-964-5783
Practice Address - Street 1:781 GRAND CASINO BLVD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1005
Practice Address - Country:US
Practice Address - Phone:405-964-5770
Practice Address - Fax:405-964-5785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100244300FMedicaid
OK100211300EMedicaid
OK100244300GMedicaid
OK371877Medicare Oscar/Certification
OK100244300FMedicaid