Provider Demographics
NPI:1447143532
Name:CHOCTAW NATION OF OKLAHOMA
Entity type:Organization
Organization Name:CHOCTAW NATION OF OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALLMARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-567-7115
Mailing Address - Street 1:1300 E MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:OK
Mailing Address - Zip Code:74728-4160
Mailing Address - Country:US
Mailing Address - Phone:918-567-7000
Mailing Address - Fax:918-567-7181
Practice Address - Street 1:1300 E MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:OK
Practice Address - Zip Code:74728-4160
Practice Address - Country:US
Practice Address - Phone:918-567-7000
Practice Address - Fax:918-567-7181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center