# NORTHEASTERN HEALTH SYSTEM

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fort Gibson Medical Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013458652
- **Authorized official:** JULIE WARD (CFO)
- **Authorized official phone:** (918) 453-2120

## Contact information

- **Practice address:** 104 LONE OAK CIR, FORT GIBSON, OK 74434-5001
- **Practice address phone:** (918) 478-2101
- **Practice address fax:** (918) 478-6008
- **Mailing address:** PO BOX 500, TAHLEQUAH, OK 74465-0500
- **Mailing address phone:** (918) 478-2101
- **Mailing address fax:** (918) 478-6008

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/15/2017
- **Last updated:** 04/06/2026