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General NPI Number Information
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NPI Number | 1306384821
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Entity Type | Organization
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Legal Business Name | CHOCTAW NATION OF OKLAHOMA
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 1801 CHUKKA HINA
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City | DURANT
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State | OK
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Zip | 74701-3085
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Country | US
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Telephone | 580-920-2100
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Fax | 580-924-7215
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Provider Business Mailing Address
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Address Line | PO BOX 1577
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City | DURANT
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State | OK
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Zip | 74702-1577
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Country | US
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Telephone | 580-920-2100
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Fax | 580-924-7215
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Authorized Official
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Title or Position | CEO
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Name | MRS. TERESA KAY JACKSON
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Credential |
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Telephone | 918-567-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP0904X
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Taxonomy Name | Federal Public Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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