Healthcare Provider Details

I. General information

NPI: 1972848703
Provider Name (Legal Business Name): CHEROKEE HILLS FAMILY MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2028 MAHANEY AVE
TAHLEQUAH OK
74464-5783
US

IV. Provider business mailing address

2028 MAHANEY AVE
TAHLEQUAH OK
74464-5783
US

V. Phone/Fax

Practice location:
  • Phone: 918-456-0001
  • Fax: 918-456-6383
Mailing address:
  • Phone: 918-456-0001
  • Fax: 918-456-6383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DONN R TURNER
Title or Position: OWNER
Credential: D.O.
Phone: 918-456-0001