=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396173449
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHOCTAW NATION OF OKLAHOMA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2013
-----------------------------------------------------
Last Update Date | 12/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 CHUKKA HINA
-----------------------------------------------------
City | DURANT
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74701-3085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-920-2100
-----------------------------------------------------
Fax | 580-924-7215
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1801 CHUKKA HINA
-----------------------------------------------------
City | DURANT
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74701-3085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-920-2100
-----------------------------------------------------
Fax | 580-924-7215
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. TERESA KAY JACKSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-567-7000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP0904X
-----------------------------------------------------
Taxonomy Name | Federal Public Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282NR1301X
-----------------------------------------------------
Taxonomy Name | Rural Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------