NPIMap

Organization Active NPI

Northeastern Health System

  • Medicare Defined Swing Bed Hospital Unit
  • Tahlequah, OK
National Provider Identifier
1104567791
Registry record updated Apr 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
NORTHEASTERN HEALTH SYSTEM
Practice address
1400 E Downing St
Tahlequah, OK 74464-3324
Phone
(918) 456-0641
Fax
(918) 772-4505
NPI assigned
Apr 6, 2022
Last updated
Apr 6, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHEASTERN HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 6, 2022

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

Authorized official

Name
James Theodore Berry
Title
Evp/Hospital Administrator
Phone
(918) 453-2263

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X NU Primary

Addresses

Primary practice location

1400 E Downing St
Tahlequah, OK 74464-3324

Mailing address

PO Box 1008
Tahlequah, OK 74465-1008
Phone (918) 458-2457

Other names 1

  • Northeastern Health System Swingbed Other name

National Provider Directory

National Provider Directory
Tax ID family
Tahlequah City Hospital7 organizations share this tax ID, including this one
Part of
Tahlequah City Hospital

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1649203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649203200000",
    "number": "1104567791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1008",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744651008",
            "telephone_number": "918-458-2457",
            "fax_number": "918-772-4505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E DOWNING ST",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744643324",
            "telephone_number": "918-456-0641",
            "fax_number": "918-772-4505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEASTERN HEALTH SYSTEM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHEASTERN HEALTH SYSTEM",
        "enumeration_date": "2022-04-06",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "THEODORE",
        "authorized_official_title_or_position": "EVP/HOSPITAL ADMINISTRATOR",
        "authorized_official_telephone_number": "918-453-2263"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northeastern Health System Swingbed",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Tahlequah, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2022; 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.