Tahlequah Family Medicine Clinic

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

14708 Issued in OK

Legal business name

TAHLEQUAH FAMILY MEDICINE CLINIC

Practice address

204 Woodlawn Ave
Tahlequah, OK 74464-3318

Phone

(918) 456-8000

NPI assigned

Jun 9, 2014

Last updated

Jun 9, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Larry Dean Sumner, MDNPI 1699761981

Title

Physician

Phone

(918) 456-8000

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Larry Dean Sumner, M.D.

  • Adult Medicine Physician
  • Tahlequah, OK
  • NPI 1699761981
  Medicare reassignment Authorized official
• Marsha Lynn Bunney, CNS

  • Adult Psychiatric/Mental Health Clinical Nurse Specialist
  • Muskogee, OK
  • NPI 1366440703
  NPD (past)
• Robert V Hensley, D.O.

  • Psychiatry Physician
  • Tahlequah, OK
  • NPI 1831136407
  NPD (past)
• Deborah Sue Jennings, M.D.

  • Psychiatry Physician
  • Tahlequah, OK
  • NPI 1548249964
  NPD (past)
• Melinda Anne Shaver, PSY.D.

  • Clinical Neuropsychologist
  • Independence, KS
  • NPI 1427061209
  NPD (past)

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

{
    "created_epoch": "1402272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402272000000",
    "number": "1144633041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 TOMMYE LN",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744644173",
            "telephone_number": "918-456-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 WOODLAWN AVE",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744643318",
            "telephone_number": "918-456-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAHLEQUAH FAMILY MEDICINE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-09",
        "last_updated": "2014-06-09",
        "status": "A",
        "authorized_official_last_name": "SUMNER",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "918-456-8000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "OK",
            "license": "14708",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOONERCARE",
            "identifier": "100124340B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Staci Lynn Tackett, PHARM D
• Gary Scott Taggart, PA-C
• Tahlequah City Hospital
• Tahlequah Dental Care PLLC
• Tahlequah Drug Company LLC (Tahlequah Drug Company)
• Tahlequah Family Vision Clinic, PLLC (Tahlequah Family Vision Clinic)
• Tahlequah Internal Medicine Inc
• Tahlequah Medical Associates
• Tahlequah Medical Group LLC
• Tahlequah Orthopedic Surgery Services, LLC

• Primary Care Clinic/Center in Tahlequah, OK
• Providers in Tahlequah, OK by specialty
• Primary Care Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.