NPIMap

Organization Active NPI

Chickasaw Nation Division of Health Chickasaw Nation Medical Center

  • Primary Care Clinic/Center
  • Ada, OK
National Provider Identifier
1962563148
Registry record updated Aug 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
CHICKASAW NATION DIVISION OF HEALTH CHICKASAW NATION MEDICAL CENTER
Practice address
1007 N Country Club Rd
Ada, OK 74820-2847
Phone
(580) 436-4585
Fax
(580) 421-4552
NPI assigned
Dec 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2018

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

Authorized official

Name
Kirbi Meeks
Title
Contract Management Coordinator
Phone
(580) 421-4570

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1007 N Country Club Rd
Ada, OK 74820-2847

Mailing address

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

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

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
Overall star rating
5 of 5
Type
Acute Care Hospitals
Ownership
Tribal
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

1925 Warrior Way
Ada, OK 74820

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

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": "1534464000000",
    "number": "1962563148",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 N COUNTRY CLUB RD",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748202847",
            "telephone_number": "580-436-4585",
            "fax_number": "580-421-4552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICKASAW NATION DIVISION OF HEALTH CHICKASAW NATION MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2018-08-17",
        "status": "A",
        "authorized_official_last_name": "MEEKS",
        "authorized_official_first_name": "KIRBI",
        "authorized_official_title_or_position": "CONTRACT MANAGEMENT COORDINATOR",
        "authorized_official_telephone_number": "580-421-4570"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ada, OK

Sources for this page

Verify at the official NPI Registry.