Healthcare Provider Details

I. General information

NPI: 1104344027
Provider Name (Legal Business Name): CHOCTAW NATION OF OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHOCTAW WAY
TALIHINA OK
74571-2022
US

IV. Provider business mailing address

PO BOX 1577
DURANT OK
74702-1577
US

V. Phone/Fax

Practice location:
  • Phone: 918-567-7000
  • Fax:
Mailing address:
  • Phone: 580-916-9140
  • Fax: 580-916-9142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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