1588667760 NPI number — CHEROKEE NATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588667760 NPI number — CHEROKEE NATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHEROKEE NATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHEROKEE NATION EMS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588667760
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 977
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAHLEQUAH
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74465-0977
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-453-5648
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22114 S BALD HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAHLEQUAH
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74464-1519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-458-5403
Provider Business Practice Location Address Fax Number:
918-458-4488
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SUMMERLIN
Authorized Official First Name:
JIMMY
Authorized Official Middle Name:
Authorized Official Title or Position:
EMS DIRECTOR
Authorized Official Telephone Number:
918-453-5025

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  EMS263 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100729250B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590005278 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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