Organization
TAHLEQUAH ORTHOPEDIC SURGERY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER SARRETT DELOACHE D.O. (OWNER)
(918) 456-6848
Entity
Organization
Contact information
Practice address
1373 E. BOONE ST., SUITE 3401, TAHLEQUAH, OK 74464-3379
(918) 456-6848
(918) 456-1150
Mailing address
1373 E. BOONE ST., SUITE 3401, TAHLEQUAH, OK 74464-3379
(918) 456-6848
(918) 456-1150
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
207X00000X
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200076030A
—
OK
01
—
448746259004
BLUE CROSS AND BLUE SHIEL
OK
Enumeration date
04/12/2007
Last updated
08/30/2012
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