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NPI Code Detail

MEDICARE: NORTHEASTERN HEALTH SYSTEM

MEDICARE: NORTHEASTERN HEALTH SYSTEM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies2178OK
2207P00000XEmergency Medicine Physician2178OK
3282N00000XGeneral Acute Care Hospital2178OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000370089001OTHEROKBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003865999
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHEASTERN HEALTH SYSTEM
Provider Business Mailing Address
First Line : 1400 E DOWNING ST
Second Line :
City : TAHLEQUAH
State : OK
Zip : 74464-3324
Country : US
Telephone Number : 918-456-0641
Fax Number : 918-456-8886
Provider Business Practice Location Address
First Line : 1400 E DOWNING ST
Second Line :
City : TAHLEQUAH
State : OK
Zip : 74464-3324
Country : US
Telephone Number : 918-456-0641
Fax Number : 918-456-8886
Authorized Official
Title or Position : CEO
Name : MR. JAMES BERRY
Credential :
Telephone Number : 918-456-0641
Provider Enumeration Date : 05/08/2006
Last Update Date : 06/01/2026

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Directions to “NORTHEASTERN HEALTH SYSTEM ” Practice Location

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