Choctaw Nation of Oklahoma
Organization Active NPI Primary Care Clinic/Center · Hugo, OK
NPI 1174599088 · NPPES record last updated Aug 21, 2025
Key facts
- NPI
- 1174599088
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- CHOCTAW NATION OF OKLAHOMA
- Practice address
- 410 North M
Hugo, OK 74743 - Phone
- (918) 567-7000
- Fax
- (918) 567-7041
- NPI assigned
- Feb 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Teresa Kay Jackson
- Title
- Administator
- Phone
- (918) 567-7000
Owners & managing parties with NPI records 10
Other NPIs on the same Medicare enrollment 10
Practitioners 52
-
Jae Lynn Alikor, P-LMSW
-
Stephen Arthur Back, D.O.
-
Brenda Gayle Chadwick-Liechti, M.S.C., LPC, CM-A
-
Jonathan A Doyle, M.D.
-
Olin W Fenton, OD
-
Joaquin Mauricio Forbes, M.D.
-
Herve Arthur Lucier, PA-C
-
Michael R Mason, MD
-
Patrick Mason, MD
-
Lisa Meredith, MBS, LPC, LADC
-
Roberta I Neely, RPT
-
Bethany Marie Patterson, PT, DPT
-
Madhusudan G Rao, MD
-
Jaclyn Deann Rouse, O.D.
-
Timothy D Thomas, DPM
-
Quinton Tieu, D.O.
-
Brooke White, D.O.
-
Natalie Elaine Armijo, M.D.
-
Anwar Naif Barnouti, M. D.
Affiliated clinicians 209
-
Crystal Abbott, APRN, PMHNP-BC
-
Erin Canaday Adams, RD, LD
-
Dean Newton Anderson, P.A.-C
-
Michael H Arredondo, M.D.
-
Brian Ayres, OD
-
Dee Duane Baughman, D.O.
-
Natasha Nichole Bray, D.O.
-
Donald E Brooks, D.O.
-
Paula Sue Brown, NP
-
Bob Burlison, P.A.-C
-
Allison Elaine Burns, PA-C
-
Larry Leon Burns Jr., PA - C
-
Baleigh Carano, NP
-
Samantha Chandler Herbert, APRN CNP
-
Angela Sue Charlton, O.D.
-
Jinok Chung, DO
-
Ashton Clayborn, D.O.
-
Kylah Chey Anne Clifft, N.P.
-
Payden Cloud, OD
Medicare Care Compare: Hospital
- Listed as
- Choctaw Nation Health Services Authority
- Type
- Acute Care Hospitals
- Ownership
- Tribal
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX
Hospital certification: CCN 370172
- Legal name
- CHOCTAW NATION OF OKLAHOMA
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Mar 9, 1977
- Last certification
- Oct 17, 2023
- Beds
- 44
- Ownership / control type
- Tribal
- Organization structure
- Other · Proprietary
- Incorporated
- Oct 1, 2013 in OK
- Enrollment address
- 2204 E Main STR
Choctaw Nation Health Care
Stigler, OK 74462-2822 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Choctaw Nation of Oklahoma |
Operational/Managerial Control | Jul 1, 2001 | |
| Teresa Jackson |
Corporate Officer | Aug 16, 2007 | |
| W-2 Managing Employee | Aug 16, 2007 | ||
| Kelly D Mings |
Corporate Officer | Aug 16, 2007 | |
| W-2 Managing Employee | Aug 16, 2007 | ||
| Todd Hallmark |
Corporate Officer | Nov 1, 2013 | |
| W-2 Managing Employee | Nov 1, 2013 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031106000326 | TX | Part B Supplier - Clinic/Group Practice | 1759294838 |
Receives reassigned benefits from 627 practitioners 10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Talihina, OK; Broken Bow, OK; Stigler, OK; Poteau, OK; McAlester, OK; Hugo, OK; Durrant, OK; Atoka, OK… |
| O20110316000039 | TX | Part a Provider - Hospital | 1759294838 |
10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Durant, OK; Talihina, OK; Stigler, OK; Poteau, OK; McAlester, OK; Idabel, OK; Hugo, OK; Broken Bow, OK… |
National Provider Directory
Locations
1300 E Martin Luther King Dr
Broken Bow, OK 74728
Phone (580) 208-2204
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federal Public Health Clinic/Center | 261QP0904X | |||
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
410 North M
Hugo, OK 74743
Mailing address
1 Choctaw Way
Talihina, OK 74571-2022
Phone (918) 567-7000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100699600J | Medicaid | OK |
Other names
- Choctaw Nation Health Clinic-Hugo
Other providers in Hugo, OK
- Centerwell Certified Healthcare Corp.
- Debbie R Childers
- Choctaw County Ambulance Authority
- Choctaw County City of Hugo Hospital Authority
- Choctaw County Youth Services, Inc.
- Choctaw Nation of Oklahoma
- Dana Clark-Jenkins
- Diana Clark
- Bambi A Clay
- Ronan Gary Cloud
All providers in Hugo, OK · Primary Care Clinic/Center in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.