NPIMap

Organization Active NPI

Chickasaw Nation Division of Health

Doing business as Chickasaw Nation Tishomingo Clinic

  • Primary Care Clinic/Center
  • Tishomingo, OK
National Provider Identifier
1649330242
Registry record updated Jul 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
CHICKASAW NATION DIVISION OF HEALTH
Doing business as
Chickasaw Nation Tishomingo Clinic
Practice address
817 E 6TH St
Tishomingo, OK 73460-1800
Phone
(580) 371-2392
NPI assigned
Dec 12, 2006
Last updated
Jul 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2025

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

Authorized official

Name
Denise Carpenter
Title
Contract Management Coordinator
Phone
(580) 421-4570

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Federal Public Health Clinic/Center 261QP0904X
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

817 E 6TH St
Tishomingo, OK 73460-1800

Mailing address

1925 Warrior Way
Ada, OK 74820
Phone (580) 421-4570

Other names 1

  • Chickasaw Nation Tishomingo Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040108000364 TX Part B Supplier - Clinic/Group Practice 8426957523 Receives reassigned benefits from 353 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ada, OK; Tishomingo, OK; Purcell, OK; Ardmore, OK
O20041029000793 TX Part A Provider - Hospital 8426957523 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ada, OK; Ardmore, OK; Purcell, OK; Tishomingo, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649330242. Details of each certification follow.

Hospital certification: CCN 370180

Legal name
CHICKASAW NATION DIVISION OF HEALTH
Doing business as
CHICKASAW NATION MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Dec 10, 1980
Last certification
Feb 16, 2024
Beds
72
Ownership / control type
Tribal
Organization structure
OtherNon-profit
Enrollment address
1921 Stonecipher Boulevard
Chickasaw Nation Department of Health
Ada, OK 74820-3439
Hospital subgroups
General

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Chickasaw Nation Medical CenterCCN 370180 · All quality measures
Overall star rating
5 of 5
Type
Acute Care Hospitals
Ownership
Tribal
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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
37D2264869Chickasaw Nation Tishomingo Clinic817 E 6TH St, Tishomingo, OK 73460Certificate of waiverJul 19, 2028

National Provider Directory

National Provider Directory

Locations

817 E 6th St
Tishomingo, OK 73460
Phone (580) 371-2392

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Brenda Teel Individual Corporate DirectorExecutive Director of Revenue Jul 1, 2015
W-2 Managing Employee Aug 22, 2003
Kevin Meeks Individual Corporate Director Sep 14, 2020
Chickasaw Nation Division of Health Organization, Ada, OK Operational/Managerial Control Oct 1, 1994

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 123

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 123

Affiliated clinicians 237

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 237

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": "1752105600000",
    "number": "1649330242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 WARRIOR WAY",
            "city": "ADA",
            "state": "OK",
            "postal_code": "74820",
            "telephone_number": "580-421-4570",
            "fax_number": "580-421-6283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 E 6TH ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734601800",
            "telephone_number": "580-371-2392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICKASAW NATION DIVISION OF HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2025-07-10",
        "certification_date": "2025-07-10",
        "status": "A",
        "authorized_official_last_name": "CARPENTER",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "CONTRACT MANAGEMENT COORDINATOR",
        "authorized_official_telephone_number": "580-421-4570"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP0904X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, Federal",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chickasaw Nation Tishomingo Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tishomingo, OK

Sources for this page

Verify at the official NPI Registry.