Provider Demographics
NPI:1922397140
Name:CHICKASAW NATION
Entity Type:Organization
Organization Name:CHICKASAW NATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-767-8942
Mailing Address - Street 1:1603 S GREEN AVE
Mailing Address - Street 2:BOX 1620
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-6210
Mailing Address - Country:US
Mailing Address - Phone:405-527-4973
Mailing Address - Fax:405-527-8058
Practice Address - Street 1:1603 S GREEN AVE
Practice Address - Street 2:BOX 1620
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-6210
Practice Address - Country:US
Practice Address - Phone:405-527-4973
Practice Address - Fax:405-527-8058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center