CHOCTAW NATION OF OKLAHOMA


Address: 109 Kerr Ave, Poteau, OK 74953-5270
Phone: 9185677096

CHOCTAW NATION OF OKLAHOMA (NPI# 1851448526) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1851448526
Entity Type Organization
Organization Name CHOCTAW NATION OF OKLAHOMA
Other Organization Name CHOCTAW NATION RUBIN WHITE POTEAU CLINIC PHARMACY
Practice Address 109 Kerr Ave
Poteau
OK 74953-5270
Practice Telephone 9185677096
Practice Fax Number 9185677041
Mailing Telephone 9185677096
Mailing Fax Number 9185677041
Enumeration Date 2007-01-04
Last Update Date 2013-05-07
Authorized Official Name MRS. TERESA K JACKSON (ADMINISTRATOR)
Authorized Official Telephone 9185677000
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 261Q00000X Clinic/Center 19-3887 OK Ambulatory Health Care Facilities
Y 332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 19-5161 OK Suppliers

Other Provider Identifier

State Issuer Identifier Type Code
OK 100244980B 05

Other Provider/Organization Names

Other Name Type Code
Choctaw Nation Rubin White Poteau Clinic Pharmacy Doing Business As Name - Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1982992269 Choctaw Nation of Oklahoma Clinic/Center 205 Dallas St, Talihina, OK 74571-2402 2011-07-20
1902078728 Choctaw Nation of Oklahoma Clinic/Center 1201 W Liberty Rd, Atoka, OK 74525-1639 2008-04-01
1174599088 Choctaw Nation of Oklahoma Clinic/Center 410 North M, Hugo, OK 74743 2006-02-28
1770559619 Choctaw Nation of Oklahoma Clinic/Center 205 E 3rd St, Broken Bow, OK 74728-4119 2006-02-28
1104344027 Choctaw Nation of Oklahoma Clinic/Center 1 Choctaw Way, Talihina, OK 74571-2022 2017-08-30
1306384821 Choctaw Nation of Oklahoma Clinic/Center 1801 Chukka Hina, Durant, OK 74701-3085 2017-02-03
1295142115 Choctaw Nation of Oklahoma Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 1801 Chukka Hina, Durant, OK 74701 2014-07-14
1396173449 Choctaw Nation of Oklahoma Clinic/Center 1801 Chukka Hina, Durant, OK 74701-3085 2013-10-29
1659674455 Choctaw Nation of Oklahoma General Acute Care Hospital 1 Choctaw Way, Talihina, OK 74571-2022 2010-12-16
1790833564 Choctaw Nation of Oklahoma Clinic/Center 902 E Lincoln Rd, Idabel, OK 74745-7337 2007-01-08

Other Data Sources

Entity Type Entity Name Entity Address
System for Award Management (SAM) Entities CHOCTAW NATION OF OKLAHOMA 1802 Chukka Hina, Durant, OK 74701-7117

Office Location

Street Address 109 KERR AVE
City POTEAU
State OK
Zip Code 74953-5270

Providers in the same location

NPI Name Taxonomy Address Enumeration
1134105059 Frank Jay Smith Physician Assistant 109 Kerr Ave, Poteau, OK 74953-5270 2005-12-22
1134690944 Crystal D Hensley Registered Nurse 109 Kerr Ave, Poteau, OK 74953-5270 2018-12-06
1174004139 Alex Nevitt Physical Therapist 109 Kerr Ave, Poteau, OK 74953-5270 2018-08-27
1780136705 Choctaw Nation Health Services Authority Clinic/Center 109 Kerr Ave, Poteau, OK 74953-5270 2016-10-25
1316493380 Megan Schmidt Pharmacist 109 Kerr Ave, Poteau, OK 74953-5270 2016-08-30
1669838983 Michelle Rene Dawson Physician Assistant 109 Kerr Ave, Poteau, OK 74953-5270 2016-01-04
1578938064 Jammie Owens Pharmacist 109 Kerr Ave, Poteau, OK 74953-5270 2015-12-09
1457734063 Jennifer Dillard Optometrist 109 Kerr Ave, Poteau, OK 74953-5270 2015-06-30
1063847556 Stefanie Janine Terrell Pharmacist 109 Kerr Ave, Poteau, OK 74953 2013-09-04
1841549318 Jessica Lois Hall Physician Assistant 109 Kerr Ave, Poteau, OK 74953-5270 2012-08-30
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1235644550 Kim Lynn Mcconnell Case Manager/Care Coordinator 907 Grace St., Poteau, OK 74953 2017-12-08
1356889745 Brenda Stacy Prevention Professional 507 Drwey, Potesu, OK 74953 2017-02-06
1639621451 Sabrina Danielle Minor Case Manager/Care Coordinator 15715 Greentop Road, Poteau, OK 74953 2016-10-27
1902352545 Daniel Jesse Bruesch Counselor 600 Oklahoma Ave., Poteau, OK 74953 2016-09-01
1578912465 Jo Ann Walden Counselor 507 Dewey Avenue, Poteau, OK 74953 2016-06-10
1154708477 Kendal Repass Specialist/Technologist 17100 Nail Creek, Poteau, OK 74953 2015-05-06
1669891768 Jennifer Branscum Case Manager/Care Coordinator 22681 Valley View Rd, Poteau, OK 74953 2014-04-16
1437582145 Kim Loggains Counselor 2104 A-n. Broadway, Poteau, OK 74953 2013-08-16
1457783573 Derek Morris Counselor 3111b N. Broadway St., Box 34, Poteau, OK 74953 2013-07-31
1568743177 Carol Ann Oliver Counselor 34183 Country Club Lane, Poteau, OK 74953 2011-09-09
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Taxonomy Information

Taxonomy Code 332800000X
Grouping Suppliers
Classification Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy

Taxonomy Definition

An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603.
Notes: Source: The Medicare Prescription Drug, Improvement and Modernization Act of 2003 [1/1/2006: new]

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1639472970 Carnegie Indian Health Clinic Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 212 E. 4th St, Carnegie, OK 73015 2010-12-08
1568512374 Wewoka Ihs Pharmacy Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy Intersection of Hwy 56 and 270, Wewoka, OK 74884 2007-01-12
1316097389 Anadarko Ihs Pharmacy Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 115 Ne Old Town Rd, Anadarko, OK 73005-5009 2007-01-11
1538219431 El Reno Ihs Pharmacy Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 1801 Parkview Drive, El Reno, OK 73632 2007-01-11
1871663203 Sac & Fox Nation Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 356110 E 930 Rd, Stroud, OK 74079-5184 2006-11-09
1699790543 Li-si-wi-nwi Health, Inc Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 15951 Little Axe Drive, Norman, OK 73026-9001 2006-07-13
1952303190 Pawhuska Ihs Pharmacy Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 715 Grandview Ave, Pawhuska, OK 74056-3201 2005-06-01
1568839470 Osage Nation Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 715 Grandview Ave, Pawhuska, OK 74056-3201 2015-08-26
1295142115 Choctaw Nation of Oklahoma Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 1801 Chukka Hina, Durant, OK 74701 2014-07-14
1598053993 Citizen Potawatomi Nation West Clinic Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 781 Grand Casino Blvd, Shawnee, OK 74804-1005 2011-07-19
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City POTEAU
Zip Code 74953

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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