Provider Demographics
NPI:1033587076
Name:CHICKASAW NATION DIVISION OF COMMERCE
Entity type:Organization
Organization Name:CHICKASAW NATION DIVISION OF COMMERCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:THARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-421-8777
Mailing Address - Street 1:2080 W STATE HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-9795
Mailing Address - Country:US
Mailing Address - Phone:405-322-6800
Mailing Address - Fax:405-322-6804
Practice Address - Street 1:2080 W STATE HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-9795
Practice Address - Country:US
Practice Address - Phone:405-322-6800
Practice Address - Fax:405-322-6804
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOVEREIGN FAMILY CLINIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care