NPIMap

Organization Active NPI

Chickasaw Nation Division of Health

Doing business as Tishomingo Indian Clinic Pharmacy

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Tishomingo, OK
National Provider Identifier
1750406757
Registry record updated Feb 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
License
61-6174 Issued in OK
Legal business name
CHICKASAW NATION DIVISION OF HEALTH
Doing business as
Tishomingo Indian Clinic Pharmacy
Practice address
817 E 6TH St
Tishomingo, OK 73460-1800
Phone
(580) 371-2392
Fax
(580) 421-4552
NPI assigned
Mar 20, 2007
Last updated
Feb 10, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2015

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) 272-2710

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X 61-6174 OK Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

817 E 6TH St
Tishomingo, OK 73460-1800

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
100244600BMedicaidOK
2074771OtherPK

Other names 1

  • TISHOMINGO INDIAN CLINIC PHARMACY 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
37D2064290Tishomingo Indian Health Clinic Pharmacy817 East 6TH St, Tishomingo, OK 73460Certificate of waiverAug 16, 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": "1423526400000",
    "number": "1750406757",
    "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": "817 E 6TH ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734601800",
            "telephone_number": "580-371-2392",
            "fax_number": "580-421-4552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICKASAW NATION DIVISION OF HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2015-02-10",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "ZACH",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "580-272-2710",
        "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": "61-6174",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100244600B",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2074771",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TISHOMINGO INDIAN CLINIC PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tishomingo, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2015; 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.