Provider Demographics
NPI:1972802346
Name:CHICKASAW NATION FRS - NORMAN
Entity type:Organization
Organization Name:CHICKASAW NATION FRS - NORMAN
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:40405-767-8942
Mailing Address - Street 1:3200 MARSHALL AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-8033
Mailing Address - Country:US
Mailing Address - Phone:405-767-8940
Mailing Address - Fax:405-767-8949
Practice Address - Street 1:3200 MARSHALL AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-8033
Practice Address - Country:US
Practice Address - Phone:405-767-8940
Practice Address - Fax:405-767-8949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center