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General NPI Number Information
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NPI Number | 1770322422
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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 | 05/22/2024
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 508 N HWY 271
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City | ANTLERS
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State | OK
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Zip | 74523
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Country | US
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Telephone | 918-567-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 1 CHOCTAW WAY
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City | TALIHINA
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State | OK
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Zip | 74571-2022
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE OFFICER
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Name | TODD A HALLMARK
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Credential |
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Telephone | 918-567-7115
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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