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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