Provider Demographics
NPI:1659388965
Name:CHEROKEE NATION
Entity Type:Organization
Organization Name:CHEROKEE NATION
Other - Org Name:SAM HIDER HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, HEALTH SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-253-1700
Mailing Address - Street 1:PO BOX 1069
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-1069
Mailing Address - Country:US
Mailing Address - Phone:539-234-2694
Mailing Address - Fax:539-234-2475
Practice Address - Street 1:859 E. MELTON DRIVE
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346-4205
Practice Address - Country:US
Practice Address - Phone:918-253-4271
Practice Address - Fax:918-253-4938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QM1300X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700620AMedicaid
OK370171OtherMEDICARE PART A
OK100700620 AMedicaid
OK100700620AMedicaid
OK370171OtherMEDICARE PART A
OK5380990009Medicare NSC