NPIMap

Organization Active NPI

Chickasaw Nation Division of Health

Doing business as Chickasaw Nation Refill Center

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Ada, OK
National Provider Identifier
1487715587
Registry record updated Mar 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
License
235613 Issued in OK
Legal business name
CHICKASAW NATION DIVISION OF HEALTH
Doing business as
Chickasaw Nation Refill Center
Practice address
933 N Country Club Rd
Ada, OK 74820-2845
Phone
(580) 272-5710
Fax
(580) 272-5711
NPI assigned
Dec 12, 2006
Last updated
Mar 9, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2016

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

Authorized official

Name
Zach Williams, RPH
Title
Pharmacist
Phone
(580) 272-5710

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X 235613 OK Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

933 N Country Club Rd
Ada, OK 74820-2845

Mailing address

933 N Country Club Rd
Ada, OK 74820-2845
Phone (580) 272-5710

Other names 1

  • Chickasaw Nation Refill Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180323000394 OK DME Supplier - Indian Health Service Or Tribal Facility 8426957523 Practice locations: Ada, OK

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Chickasaw Nation Refill Center933 N Country Club Rd, Ada, OK 74820-2845(580) 421-8725 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order) Accepts assignmentParticipating since Jul 1, 2001

National Provider Directory

National Provider Directory
Tax ID family
CNHS Finance13 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.

Locations

933 N Country Club Rd
Ada, OK 74820
Phone (580) 272-5710

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Chickasaw Nation Medical CenterAda, OK, CCN 370180 Hospital Operational/Managerial Control Oct 1, 1994
Minticha ApilaAda, OK, CCN 377876 Home health agency Operational/Managerial Control (100%) Oct 1, 1994

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457481600000",
    "number": "1487715587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "933 N COUNTRY CLUB RD",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748202845",
            "telephone_number": "580-272-5710",
            "fax_number": "580-272-5711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "933 N COUNTRY CLUB RD",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748202845",
            "telephone_number": "580-272-5710",
            "fax_number": "580-272-5711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICKASAW NATION DIVISION OF HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2016-03-09",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "ZACH",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "580-272-5710",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "OK",
            "license": "235613",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chickasaw Nation Refill Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ada, OK

Sources for this page

Verify at the official NPI Registry.