Eastside Clinic

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

15674 Issued in OK

Legal business name

EASTSIDE CLINIC

Practice address

22408 Highway 51
Tahlequah, OK 74464-2058

Phone

(918) 456-6250

Fax

(918) 456-4080

NPI assigned

Jan 30, 2008

Organization subpart

Yes

Parent organization

EASTSIDE CLINICAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. James Mark Seratt, M.D.NPI 1568453918

Title

Owner/Doctor

Phone

(918) 456-6250

Specialties & licenses 1

Addresses

Other identifiers 4

Part of

Eastside Clinic

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• James Mark Seratt, MD

  • Family Medicine Physician
  • Tahlequah, OK
  • NPI 1568453918
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217203200000",
    "number": "1023295193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 59",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744650059",
            "telephone_number": "918-456-6250",
            "fax_number": "918-456-4080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22408 HIGHWAY 51",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744642058",
            "telephone_number": "918-456-6250",
            "fax_number": "918-456-4080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EASTSIDE CLINIC",
        "enumeration_date": "2008-01-30",
        "last_updated": "2008-07-28",
        "status": "A",
        "authorized_official_last_name": "SERATT",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "918-456-6250",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "15674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4111208",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "C95468",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110118510A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS AND BLUESHIELD",
            "identifier": "445569081002",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Wayne Easley II
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• Amanda Edwards, LPC-S
• Coy Joe Edwards, M.D.
• Eeg Corporation

• Family Medicine Physician in Tahlequah, OK
• Providers in Tahlequah, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.