Provider Demographics
NPI:1871596569
Name:CHEROKEE SERVICES
Entity type:Organization
Organization Name:CHEROKEE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:REAN
Authorized Official - Last Name:HUXALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, CGP,FASCP
Authorized Official - Phone:918-808-5526
Mailing Address - Street 1:22122 E 63RD ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-2007
Mailing Address - Country:US
Mailing Address - Phone:918-808-5526
Mailing Address - Fax:918-355-6158
Practice Address - Street 1:22122 E 63RD ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-2007
Practice Address - Country:US
Practice Address - Phone:918-808-5526
Practice Address - Fax:918-355-6158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK 9725332BN1400X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK26224167Medicaid