Healthcare Provider Details

I. General information

NPI: 1447143532
Provider Name (Legal Business Name): CHOCTAW NATION OF OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E MARTIN LUTHER KING DR
BROKEN BOW OK
74728-4160
US

IV. Provider business mailing address

1 CHOCTAW WAY
TALIHINA OK
74571-2022
US

V. Phone/Fax

Practice location:
  • Phone: 918-567-7000
  • Fax: 918-567-7180
Mailing address:
  • Phone: 918-567-7000
  • Fax: 918-567-7180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TODD A HALLMARK
Title or Position: EXECUTIVE OFFICER - HEALTH
Credential:
Phone: 918-567-7115