Provider Demographics
NPI:1790006112
Name:CHICKASAW NATION DIVISION OF HEALTH CHICKASAW NATION MEDICAL CENTER
Entity Type:Organization
Organization Name:CHICKASAW NATION DIVISION OF HEALTH CHICKASAW NATION MEDICAL CENTER
Other - Org Name:CHICKASAW NATION MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACT MANAGEMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIRBI
Authorized Official - Middle Name:
Authorized Official - Last Name:MEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-421-4570
Mailing Address - Street 1:1925 WARRIOR WAY
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820
Mailing Address - Country:US
Mailing Address - Phone:580-421-4570
Mailing Address - Fax:
Practice Address - Street 1:1921 STONECIPHER BLVD.
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-3439
Practice Address - Country:US
Practice Address - Phone:580-421-4570
Practice Address - Fax:580-421-6283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
370180OtherMEDICARE #