Healthcare Provider Details

I. General information

NPI: 1376826933
Provider Name (Legal Business Name): CHOCTAW NATION HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 E LINCOLN RD
IDABEL OK
74745-7337
US

IV. Provider business mailing address

1 CHOCTAW WAY
TALIHINA OK
74571-2022
US

V. Phone/Fax

Practice location:
  • Phone: 580-286-2600
  • Fax: 580-286-1087
Mailing address:
  • Phone: 918-567-7000
  • Fax: 918-567-7066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERESA JACKSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 918-567-7054