NORTHEASTERN HEALTH SYSTEM (NPI# 1013458652) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013458652 |
| Entity Type | Organization |
| Organization Name | NORTHEASTERN HEALTH SYSTEM |
| Other Organization Name | FORT GIBSON MEDICAL CLINIC |
| Practice Address |
104 Lone Oak Cir Fort Gibson OK 74434-5001 |
| Mailing Address |
Po Box 500 Tahlequah OK 74465-0500 |
| Practice Telephone | 9184782101 |
| Practice Fax Number | 9184786008 |
| Mailing Telephone | 9184782101 |
| Mailing Fax Number | 9184786008 |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2017-05-18 |
| Authorized Official Name | JULIE WARD (CFO) |
| Authorized Official Telephone | 9184532120 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Fort Gibson Medical Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366983850 | Northeastern Health System | Clinic/Center | 1203 E Ross Byp Ste A, Tahlequah, OK 74464-4158 | 2017-03-16 |
| 1306387949 | Northeastern Health System | Clinic/Center | 1201 E Ross Byp, Tahlequah, OK 74464-4188 | 2017-03-15 |
| 1871717819 | Northeastern Health System | Ambulance | 1400 E Downing St, Tahlequah, OK 74464-3324 | 2007-04-12 |
| 1457574170 | Northeastern Health System | Emergency Medicine | 1400 E Downing St, Tahlequah, OK 74464-3324 | 2007-04-11 |
| 1619031465 | Northeastern Health System | Psychiatric Unit | 1400 E Downing St, Tahlequah, OK 74464-3324 | 2006-12-19 |
| 1528122371 | Northeastern Health System | Rehabilitation Unit | 1400 E Downing St, Tahlequah, OK 74464-3324 | 2006-12-19 |
| 1003865999 | Northeastern Health System | Emergency Medicine | 1400 E Downing St, Tahlequah, OK 74464-3324 | 2006-05-08 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | NORTHEASTERN HEALTH SYSTEM | 1400 E Downing St, Tahlequah, OK 74464-3324 |
| Street Address |
104 LONE OAK CIR |
| City | FORT GIBSON |
| State | OK |
| Zip Code | 74434-5001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811180664 | Marvin Moul | Internal Medicine | 104 Lone Oak Cir, Fort Gibson, OK 74434-5001 | 2007-08-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326323296 | Janet Hulbert | Occupational Therapist | 1409 Saddlebrooke Dr, Fort Gibson, OK 74434 | 2011-10-11 |
| 1356643936 | Justin Matthew Wedman | Pharmacist | 114 N. Lee St., Fort Gibson, OK 74434 | 2010-12-02 |
| 1396980546 | Walker & Walker P.l.l.c. | Dentist | 106 Lone Oak Cr, Ft. Gibson, OK 74434 | 2008-12-02 |
| 1548305857 | Christopher Back | Family Medicine | 129 N Lee St., Fort Gibson, OK 74434 | 2007-02-21 |
| 1982794442 | Wanda Ann Teague | Speech-Language Pathologist | 500 South Ross Ave., Fort Gibson, OK 74434 | 2006-10-13 |
| 1891898912 | Scotts Pharmacy LLC | Pharmacy | 1201 S Lee St, Fort Gibson, OK 74434 | 2006-09-06 |
| 1831206671 | Charles Robert Mutch | Family Medicine | 104 Lone Oak Circle, Ft. Gibson, OK 74434 | 2006-08-25 |
| 1073511184 | Brandon Medical, LLC | Prosthetic/Orthotic Supplier | 110 North Lee Street, Fort Gibson, OK 74434 | 2005-07-12 |
| 1265761381 | Holly Jean Dawson | Obstetrics & Gynecology | 108 Lone Oak Cir, Fort Gibson, OK 74434 | 2009-12-19 |
| 1790892529 | Donald M Elgin | Family Medicine | 104 Lone Oak Circle, Ft. Gibson, OK 74434 | 2006-08-25 |
| Find all providers in zip 74434 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386245744 | Baptist Healthcare of Oklahoma, LLC | Clinic/Center | 310 2nd Ave Sw Stes 101, 102, 103, 104, 106a, 106b, 107a, 107b, 203, 207 & 208, Miami, OK 74354-6743 | 2020-11-03 |
| 1275133993 | Integris Grove Hospital | Clinic/Center | 216 S 7th St Ste 1, Vinita, OK 74301-3720 | 2020-10-30 |
| 1205436938 | Integris Bass Baptist Health Center | Clinic/Center | 1805 W Owen K Garriott Rd, Enid, OK 73703-5526 | 2020-10-30 |
| 1699385278 | Verdigris Valley Family Medicine LLC | Clinic/Center | 25965 S Highway 66 Ste B, Claremore, OK 74019-2468 | 2020-08-07 |
| 1538798897 | Stillwater Medical Center Authority | Clinic/Center | 1411 W 7th Ave Ste 201, Stillwater, OK 74074-4300 | 2020-04-07 |
| 1275161457 | Drumright Community Hospital LLC | Clinic/Center | 612 W Bypass, Drumright, OK 74030-5957 | 2020-04-01 |
| 1982237244 | Stillwater Medical Center Authority | Clinic/Center | 1116 Manvel Ave, Chandler, OK 74834-3856 | 2020-02-14 |
| 1366075616 | Stillwater Medical Center Authority | Clinic/Center | 505 E Highway 33, Perkins, OK 74059-4520 | 2020-02-14 |
| 1336772680 | Stillwater Medical Center Authority | Clinic/Center | 518 E Lakeview Rd, Stillwater, OK 74075-2825 | 2020-02-14 |
| 1447883780 | Stillwater Medical Center Authority | Clinic/Center | 600 S Linwood Ave Ste A, Cushing, OK 74023-4630 | 2020-02-14 |
| Find all providers with the same taxonomy | ||||
| City | FORT GIBSON |
| Zip Code | 74434 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.