Organization
CHOCTAW NATION OF OKLAHOMA
Active
Other names
Choctaw Nation Health Clinic-Idabel RX
Organization subpart
No
Provider details
NPI number
Authorized official
TODD A HALLMARK (EXECUTIVE OFFICER - DEPT OF HEALTH)
(918) 567-7115
Entity
Organization
Contact information
Practice address
902 E LINCOLN RD, IDABEL, OK 74745-7337
(800) 349-7026
(918) 567-7180
Mailing address
ONE CHOCTAW WAY, TALIHINA, OK 74571
(800) 349-7026
(918) 567-7180
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
255013
OK
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
255013
OK
3336C0003X
Community/Retail Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100244980F
—
OK
05
—
100244980Q
—
OK
01
—
25-5013
OK STATE BOARD OF PHARMACY
—
01
—
3724285
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/08/2007
Last updated
08/08/2025
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