=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568275048
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHEROKEE NATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2025
-----------------------------------------------------
Last Update Date | 01/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 S MOORE AVE
-----------------------------------------------------
City | CLAREMORE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74017-5047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 539-234-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1069
-----------------------------------------------------
City | TAHLEQUAH
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74465-1069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 539-234-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO - EXECUTIVE DIRECTOR HEALTH SER
-----------------------------------------------------
Name | DR. ROBERT STEPHEN JONES
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 539-234-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------