Healthcare Provider Details

I. General information

NPI: 1295399095
Provider Name (Legal Business Name): CHICKASAW NATION DIVISION OF HEALTH CHICKASAW NATION MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 CARL ALBERT BLVD STE B
ADA OK
74820-3491
US

IV. Provider business mailing address

1904 CARL ALBERT BLVD STE B
ADA OK
74820-3491
US

V. Phone/Fax

Practice location:
  • Phone: 580-272-5413
  • Fax: 580-272-1307
Mailing address:
  • Phone: 580-272-5413
  • Fax: 580-272-1307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ZACHARIAH F WILLIAMS
Title or Position: BILLING AND CONTRACTING MANAGER
Credential: PHARM. D.
Phone: 580-272-5710