# TAHLEQUAH MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** TAHLEQUAH HOSPITAL AUTHORITY
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1881960771
- **Legal business name:** TAHLEQUAH HOSPITAL AUTHORITY
- **Authorized official:** JAMES BERRY (CEO)
- **Authorized official phone:** (918) 456-0641

## Contact information

- **Practice address:** 1400 E DOWNING ST, TAHLEQUAH, OK 74464-3324
- **Practice address phone:** (918) 456-0641
- **Practice address fax:** (918) 453-2341
- **Mailing address:** 1400 E DOWNING ST, TAHLEQUAH, OK 74464-3324
- **Mailing address phone:** (918) 456-0641
- **Mailing address fax:** (918) 453-2341

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 208800000X | Urology Physician | — | NULL | — |
| 208800000X | Urology Physician | — | — | — |

## Other

- **Enumeration date:** 03/26/2012
- **Last updated:** 06/01/2026