| Tahlequah Medical Group Llc | |
|
1400 E Downing St Tahlequah OK 74464-3324 | |
| (918) 456-0641 | |
| Not Available |
| Full Name | Tahlequah Medical Group Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1400 E Downing St, Tahlequah, Oklahoma |
| Authorized Official Name and Position | Julie Ward (CFO) |
| Authorized Official Contact | 9184532120 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tahlequah Medical Group Llc 1400 E Downing St Tahlequah OK 74464-3324 Ph: () - | Tahlequah Medical Group Llc 1400 E Downing St Tahlequah OK 74464-3324 Ph: (918) 456-0641 |
| NPI Number | 1881960771 |
|---|---|
| Provider Enumeration Date | 03/26/2012 |
| Last Update Date | 03/26/2012 |
| Medicare PECOS PAC ID | 4082861349 |
|---|---|
| Medicare Enrollment ID | O20120822000336 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881960771 | NPI | - | NPPES |
| Provider Name | Donald M Elgin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790892529 PECOS PAC ID: 4486567237 Enrollment ID: I20031107000698 |
| Provider Name | John E Fell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629091640 PECOS PAC ID: 0547231391 Enrollment ID: I20040804000950 |
| Provider Name | Robert Hilton Mcdonald |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1992743066 PECOS PAC ID: 7315973682 Enrollment ID: I20050711000008 |
| Provider Name | William J Myers |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1134204852 PECOS PAC ID: 0042245185 Enrollment ID: I20051013000843 |
| Provider Name | Ryan A Pitts |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1356314603 PECOS PAC ID: 0941225023 Enrollment ID: I20051129000241 |
| Provider Name | Jason J Ballew |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1235146036 PECOS PAC ID: 4082614409 Enrollment ID: I20070110000016 |
| Provider Name | Jennifer L Mathis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548304892 PECOS PAC ID: 8426158270 Enrollment ID: I20070710000481 |
| Provider Name | Deanna Wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144321456 PECOS PAC ID: 9931297702 Enrollment ID: I20071112000373 |
| Provider Name | Diego Sebastian Humphrey |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1073525515 PECOS PAC ID: 6002980893 Enrollment ID: I20080728000398 |
| Provider Name | David B Rotton |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1548218803 PECOS PAC ID: 5991713331 Enrollment ID: I20090605000214 |
| Provider Name | Jana N Baker |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154586881 PECOS PAC ID: 5294868659 Enrollment ID: I20100805000334 |
| Provider Name | Bette Bischoff Glidewell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134309933 PECOS PAC ID: 5890979264 Enrollment ID: I20110408000270 |
| Provider Name | Creticus P Marak |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1215163514 PECOS PAC ID: 3173676822 Enrollment ID: I20130924000189 |
| Provider Name | Lori J Ford |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1740276955 PECOS PAC ID: 9133140544 Enrollment ID: I20131123000007 |
| Provider Name | Dillon R Jarrett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932514734 PECOS PAC ID: 2860618097 Enrollment ID: I20140724001650 |
| Provider Name | Jack W Casas |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1194836684 PECOS PAC ID: 3375541378 Enrollment ID: I20150325001490 |
| Provider Name | Carla Renee Hayes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891189726 PECOS PAC ID: 9335460450 Enrollment ID: I20150602000321 |
| Provider Name | Bilal Aziz |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1063725901 PECOS PAC ID: 3971814229 Enrollment ID: I20150612002036 |
| Provider Name | Florame S Jamison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093199721 PECOS PAC ID: 7810203841 Enrollment ID: I20150904001153 |
| Provider Name | Jennifer L Carter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902246150 PECOS PAC ID: 4981835352 Enrollment ID: I20160720002874 |
| Provider Name | Kelly S Marak |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1316174675 PECOS PAC ID: 3072808799 Enrollment ID: I20160819001425 |
| Provider Name | Imran Tahir |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1194012229 PECOS PAC ID: 3173827631 Enrollment ID: I20170106000797 |
| Provider Name | Jimmy Keith Ogden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548370646 PECOS PAC ID: 9931364908 Enrollment ID: I20170110001937 |
| Provider Name | Lisa Renfrow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578003927 PECOS PAC ID: 3779840350 Enrollment ID: I20171207000224 |
| Provider Name | Stephanie S Mcquarters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598284358 PECOS PAC ID: 0345294955 Enrollment ID: I20180116000408 |
| Provider Name | Stephanie Fossett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568983401 PECOS PAC ID: 9537428412 Enrollment ID: I20180123000812 |
| Provider Name | Teresa Nabors |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952832438 PECOS PAC ID: 8921353491 Enrollment ID: I20180625002085 |
| Provider Name | Muneeza Afif |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740544428 PECOS PAC ID: 9537477245 Enrollment ID: I20180730001033 |
| Provider Name | Michelle B Perry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487021580 PECOS PAC ID: 9739496910 Enrollment ID: I20190205000580 |
| Provider Name | Thomas Dwaine Schneider |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730105594 PECOS PAC ID: 3577805456 Enrollment ID: I20190424001716 |
| Provider Name | Katherine A Mosteller |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1255851523 PECOS PAC ID: 2567793516 Enrollment ID: I20191007001180 |
| Provider Name | Lea S Humphrey |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1649584855 PECOS PAC ID: 3173836871 Enrollment ID: I20191022003637 |
| Provider Name | Farhan Syed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427477223 PECOS PAC ID: 0749602894 Enrollment ID: I20200619000274 |
| Provider Name | Natasha Bray |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285840660 PECOS PAC ID: 2163516881 Enrollment ID: I20200904001186 |
| Provider Name | Matthew Christopher Smith |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1861482390 PECOS PAC ID: 6507027505 Enrollment ID: I20220210000448 |
| Provider Name | Muhammad U Farooq |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1598945156 PECOS PAC ID: 8729132857 Enrollment ID: I20220221001444 |
| Provider Name | Samiya Rashid |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1831139682 PECOS PAC ID: 5092719062 Enrollment ID: I20220310000940 |
| Provider Name | Mohammad Sajed |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1396785127 PECOS PAC ID: 3577567528 Enrollment ID: I20220428002440 |
| Provider Name | Vishal B Jani |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1134350069 PECOS PAC ID: 7214220367 Enrollment ID: I20220503001506 |
| Provider Name | Stephen R Burton |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1497735740 PECOS PAC ID: 0547223513 Enrollment ID: I20220510000543 |
| Provider Name | Saqib Chaudhry |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1902168438 PECOS PAC ID: 7517295769 Enrollment ID: I20220511000281 |
| Provider Name | Christopher C Glisson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1932254745 PECOS PAC ID: 9032204953 Enrollment ID: I20220608000484 |
| Provider Name | Celeste L Bidwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184394751 PECOS PAC ID: 4486033156 Enrollment ID: I20220627001920 |
| Provider Name | Robert E Sanders |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932188216 PECOS PAC ID: 7012802820 Enrollment ID: I20220802000812 |
| Provider Name | Madyson Blair Snow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699401547 PECOS PAC ID: 1850767187 Enrollment ID: I20221012000399 |
Eastside Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 22408 Highway 51, Tahlequah, OK 74464 Phone: 918-456-6250 Fax: 918-456-4080 | |
Lifelong Wellness Center Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1203 E Ross Byp Ste C, Tahlequah, OK 74464 Phone: 918-458-0700 Fax: 918-458-0424 | |
Donna L Schneider D O Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1323 East Downing Street, Tahlequah, OK 74464 Phone: 918-456-1009 Fax: 918-456-1025 | |
Northeastern Oklahoma Community Health Centers, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1500 E Downing St Ste 103, Tahlequah, OK 74464 Phone: 918-708-3580 Fax: 918-506-6041 | |
401 Medical Center Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 401 E Downing St, Tahlequah, OK 74464 Phone: 918-316-3764 Fax: 918-398-8982 | |
Tahlequah Ent Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1203 E Ross Byp, Tahlequah, OK 74464 Phone: 918-453-9002 Fax: 918-453-0328 | |
Tmg Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1400 E Downing St, Tahlequah, OK 74464 Phone: 918-456-0641 Fax: 918-453-2341 |