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General NPI Number Information
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NPI Number | 1003865999
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Entity Type | Organization
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Legal Business Name | NORTHEASTERN HEALTH SYSTEM
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 1400 E DOWNING ST
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City | TAHLEQUAH
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State | OK
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Zip | 74464-3324
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Country | US
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Telephone | 918-456-0641
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Fax | 918-456-8886
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Provider Business Mailing Address
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Address Line | 1400 E DOWNING ST PO BOX 1008
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City | TAHLEQUAH
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State | OK
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Zip | 74464-3324
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Country | US
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Telephone | 918-456-0641
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Fax | 918-456-8886
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Authorized Official
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Title or Position | CEO
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Name | MR. BRIAN WOODLIFF
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Credential |
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Telephone | 918-456-0641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2178
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 2178
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 2178
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License Number State | OK
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