| Northeastern Health System | |
|
1400 E Downing St Tahlequah OK 74464-3324 | |
| (918) 456-0641 | |
| Not Available |
| Full Name | Northeastern Health System |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 1400 E Downing St, Tahlequah, Oklahoma |
| Authorized Official Name and Position | Brian Woodliff (CEO) |
| Authorized Official Contact | 9184560641 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeastern Health System 1400 E Downing St Po Box 1008 Tahlequah OK 74464-3324 Ph: (918) 456-0641 | Northeastern Health System 1400 E Downing St Tahlequah OK 74464-3324 Ph: (918) 456-0641 |
| NPI Number | 1619031465 |
|---|---|
| Provider Enumeration Date | 12/19/2006 |
| Last Update Date | 08/06/2014 |
| Medicare PECOS PAC ID | 1456255025 |
|---|---|
| Medicare Enrollment ID | O20080502000094 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619031465 | NPI | - | NPPES |
| 100700680A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 2178 (Oklahoma) | Primary |
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