# EASTSIDE CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** EASTSIDE CLINIC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1023295193
- **Legal business name:** EASTSIDE CLINIC
- **Authorized official:** DR. JAMES MARK SERATT M.D. (OWNER/DOCTOR)
- **Authorized official phone:** (918) 456-6250

## Contact information

- **Practice address:** 22408 HIGHWAY 51, TAHLEQUAH, OK 74464-2058
- **Practice address phone:** (918) 456-6250
- **Practice address fax:** (918) 456-4080
- **Mailing address:** PO BOX 59, TAHLEQUAH, OK 74465-0059
- **Mailing address phone:** (918) 456-6250
- **Mailing address fax:** (918) 456-4080

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 15674 | OK | Yes |

## Other

- **Enumeration date:** 01/30/2008
- **Last updated:** 07/28/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 110118510A | — | OK |
| 01 | — | 4111208 | AETNA | OK |
| 01 | — | 445569081002 | BLUECROSS AND BLUESHIELD | OK |
| 01 | — | C95468 | UPIN | OK |