Organization
NORTHEASTERN HEALTH SYSTEM
Active
Other names
TAHLEQUAH CITY HOSPITAL
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN WOODLIFF (CEO)
(918) 456-0641
Entity
Organization
Contact information
Practice address
1400 E DOWNING ST, TAHLEQUAH, OK 74464-3324
(918) 456-0641
(918) 456-8886
Mailing address
1400 E DOWNING ST, PO BOX 1008, TAHLEQUAH, OK 74464-3324
(918) 456-0641
(918) 456-8886
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2178
OK
282N00000X
General Acute Care Hospital
Primary
2178
OK
332B00000X
Durable Medical Equipment & Medical Supplies
2178
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000370089001
BCBS
OK
05
—
100700680A
—
OK
Enumeration date
05/08/2006
Last updated
02/28/2025
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