Healthcare Provider Details

I. General information

NPI: 1992945695
Provider Name (Legal Business Name): CHOCTAW NATION HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHOCTAW WAY
TALIHINA OK
74571-2022
US

IV. Provider business mailing address

1 CHOCTAW WAY
TALIHINA OK
74571-2022
US

V. Phone/Fax

Practice location:
  • Phone: 918-567-7000
  • Fax: 918-567-7113
Mailing address:
  • Phone: 918-567-7000
  • Fax: 918-567-7113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number704
License Number StateOK

VIII. Authorized Official

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