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Organization
EASTSIDE CLINIC
Active
Organization
EASTSIDE CLINIC
Active
Parent organization
EASTSIDE CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
EASTSIDE CLINIC
Authorized official
DR. JAMES MARK SERATT M.D. (OWNER/DOCTOR)
(918) 456-6250
Entity
Organization
Contact information
Practice address
22408 HIGHWAY 51, TAHLEQUAH, OK 74464-2058
(918) 456-6250
(918) 456-4080
Mailing address
PO BOX 59, TAHLEQUAH, OK 74465-0059
(918) 456-6250
(918) 456-4080
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15674
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110118510A
—
OK
01
—
4111208
AETNA
OK
01
—
445569081002
BLUECROSS AND BLUESHIELD
OK
01
—
C95468
UPIN
OK
Enumeration date
01/30/2008
Last updated
07/28/2008
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