Provider Demographics
NPI:1962563148
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:
Other - Org Type:
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 1:1007 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2847
Practice Address - Country:US
Practice Address - Phone:580-436-4585
Practice Address - Fax:580-421-4552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TEZ006Medicare ID - Type UnspecifiedMEDICARE GROUP #
OK370180Medicare ID - Type UnspecifiedMEDICARE