Healthcare Provider Details

I. General information

NPI: 1982992269
Provider Name (Legal Business Name): CHOCTAW NATION OF OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 DALLAS ST
TALIHINA OK
74571-2402
US

IV. Provider business mailing address

205 DALLAS ST
TALIHINA OK
74571-2402
US

V. Phone/Fax

Practice location:
  • Phone: 918-567-7000
  • Fax: 918-567-7041
Mailing address:
  • Phone: 918-567-7000
  • Fax: 918-567-7041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TERESA KAY JACKSON
Title or Position: CEO
Credential:
Phone: 918-567-7054