Healthcare Provider Details

I. General information

NPI: 1588667760
Provider Name (Legal Business Name): CHEROKEE NATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22114 S BALD HILL RD
TAHLEQUAH OK
74464-1519
US

IV. Provider business mailing address

PO BOX 977
TAHLEQUAH OK
74465-0977
US

V. Phone/Fax

Practice location:
  • Phone: 918-458-5403
  • Fax: 918-458-4488
Mailing address:
  • Phone: 918-453-5648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberEMS263
License Number StateOK

VII. Legacy identifiers

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

# 1
Identifier100729250B
Identifier TypeMEDICAID
Identifier StateOK
Identifier Issuer
# 2
Identifier590005278
Identifier TypeOTHER
Identifier StateOK
Identifier IssuerRAILROAD MEDICARE

VIII. Authorized Official

Name: JIMMY SUMMERLIN
Title or Position: EMS DIRECTOR
Credential:
Phone: 918-453-5025