=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295142115
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHOCTAW NATION OF OKLAHOMA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2014
-----------------------------------------------------
Last Update Date | 08/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 CHUKKA HINA
-----------------------------------------------------
City | DURANT
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-920-2100
-----------------------------------------------------
Fax | 918-567-7180
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ONE CHOCTAW WAY
-----------------------------------------------------
City | TALIHINA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74571-2022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-567-7000
-----------------------------------------------------
Fax | 918-567-7180
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE OFFICER - DEPT OF HEALTH
-----------------------------------------------------
Name | MR. TODD A HALLMARK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-567-7115
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332800000X
-----------------------------------------------------
Taxonomy Name | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
-----------------------------------------------------
License Number | 276867
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------