Provider Demographics
NPI:1316900095
Name:CHOCTAW NATION OF OKLAHOMA-PRINCIPAL CHIEF
Entity type:Organization
Organization Name:CHOCTAW NATION OF OKLAHOMA-PRINCIPAL CHIEF
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:580-931-3636
Mailing Address - Street 1:702 BRYAN DR STE 200
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-7000
Mailing Address - Country:US
Mailing Address - Phone:580-931-3636
Mailing Address - Fax:580-931-9016
Practice Address - Street 1:702 BRYAN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-7000
Practice Address - Country:US
Practice Address - Phone:580-931-3636
Practice Address - Fax:580-931-9016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKHO4228251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKHO4228OtherHOSPICE LICENSURE
OKSW22676OtherSUBMITTER ID NUMBER
OK37D1043836OtherCLIA NUMBER