Healthcare Provider Details

I. General information

NPI: 1306384821
Provider Name (Legal Business Name): CHOCTAW NATION OF OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 CHUKKA HINA
DURANT OK
74701-3085
US

IV. Provider business mailing address

PO BOX 1577
DURANT OK
74702-1577
US

V. Phone/Fax

Practice location:
  • Phone: 580-920-2100
  • Fax: 580-924-7215
Mailing address:
  • Phone: 580-920-2100
  • Fax: 580-924-7215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TERESA KAY JACKSON
Title or Position: CEO
Credential:
Phone: 918-567-7000