1124175518 NPI number — CHOCTAW NATION OF OKLAHOMA

Table of content: (NPI 1124175518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124175518 NPI number — CHOCTAW NATION OF OKLAHOMA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHOCTAW NATION OF OKLAHOMA
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:
CHOCTAW NATION HEALTH CLINIC-MCALESTER
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:
1124175518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1127 S GEORGE NIGH EXPY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCALESTER
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74501-7143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-567-7000
Provider Business Mailing Address Fax Number:
918-567-7041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1127 S GEORGE NIGH EXPY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCALESTER
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74501-7143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-567-7000
Provider Business Practice Location Address Fax Number:
918-567-7041
Provider Enumeration Date:
01/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JACKSON
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
918-567-7000

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  15-5155 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332800000X , with the licence number: 15-5155 , 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: 100244980C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com