NPIMap

Organization Active NPI

Chickasaw Nation Division of Health

Doing business as Purcell Indian Health Clinic

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Purcell, OK
National Provider Identifier
1396860003
Registry record updated Feb 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
License
474906 Issued in OK
Legal business name
CHICKASAW NATION DIVISION OF HEALTH
Doing business as
Purcell Indian Health Clinic
Practice address
1438 Hardcastle Blvd
Purcell, OK 73080-8233
Phone
(580) 272-5710
Fax
(580) 272-5711
NPI assigned
Mar 20, 2007
Last updated
Feb 15, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Zach Williams, DPH
Title
Pharmacist
Phone
(580) 436-3980

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X 474906 OK Primary

Addresses

Primary practice location

1438 Hardcastle Blvd
Purcell, OK 73080-8233

Mailing address

1921 Stonecipher Dr
Ada, OK 74820-3439
Phone (580) 421-4597

Other identifiers 2

IdentifierTypeStateIssuer
2076971OtherPK
100689860CMedicaidOK

Other names 1

  • PURCELL INDIAN HEALTH CLINIC Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D1031161Purcell Indian Health Clinic1438 Hardcastle Blvd, Purcell, OK 73080AccreditationOct 26, 2027
37D1039209Purcell Indian Health Clinic Pharmacy1438 Hardcastle Blvd, Purcell, OK 73080Certificate of waiverApr 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
Chickasaw Nation Division of Health13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487116800000",
    "number": "1396860003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1921 STONECIPHER DR",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748203439",
            "telephone_number": "580-421-4597",
            "fax_number": "580-421-4598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1438 HARDCASTLE BLVD",
            "city": "PURCELL",
            "state": "OK",
            "postal_code": "730808233",
            "telephone_number": "580-272-5710",
            "fax_number": "580-272-5711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICKASAW NATION DIVISION OF HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2017-02-15",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "ZACH",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "580-436-3980",
        "authorized_official_credential": "DPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "OK",
            "license": "474906",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2076971",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100689860C",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PURCELL INDIAN HEALTH CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Purcell, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.