Basic Information
| Provider Information | |||||||||
| NPI: | 1982863791 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHICKASAW NATION DIVISION OF HEALTH/CHICKASAW NATION MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHICKASAW NATION MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1925 WARRIOR WAY | ||||||||
| Address2: | |||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5884214570 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1921 STONECIPHER DR | ||||||||
| Address2: | |||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748203439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5884214570 | ||||||||
| FaxNumber: | 5804216283 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2008 | ||||||||
| LastUpdateDate: | 08/20/2018 | ||||||||
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| AuthorizedOfficialLastName: | MEEKS | ||||||||
| AuthorizedOfficialFirstName: | KIRBI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTRACT MANAGEMENT COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 5804214570 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.