NPIMap

Organization Active NPI

Northeastern Health System

  • Land Ambulance
  • Tahlequah, OK
National Provider Identifier
1871717819
Registry record updated Apr 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
2178 Issued in OK
Legal business name
NORTHEASTERN HEALTH SYSTEM
Practice address
1400 E Downing St
Tahlequah, OK 74464-3324
Phone
(918) 456-0641
Fax
(918) 456-8886
NPI assigned
Apr 12, 2007
Last updated
Apr 6, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2026

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

Authorized official

Name
Brian Woodliff, CEO
Title
Ceo
Phone
(918) 456-0641

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 2178 OK Primary

Addresses

Primary practice location

1400 E Downing St
Tahlequah, OK 74464-3324

Mailing address

1400 E Downing St
Tahlequah, OK 74464-3324
Phone (918) 456-0641

Other identifiers 1

IdentifierTypeStateIssuer
100700680BMedicaidOK

Other names 1

  • TAHLEQUAH HOSPITAL AUTHORITY Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031125000250 OK Part B Supplier - Clinic/Group Practice 1456255025 Receives reassigned benefits from 159 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tahlequah, OK; Sallisaw, OK

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

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

Other organizations with this tax ID 6

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

Member organizations 7

Organizations listed as members of this organization in the National Provider Directory.

Locations

205 Harris Cir
Ste 202
Tahlequah, OK 74464
Phone (918) 207-1410

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775433600000",
    "number": "1871717819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E DOWNING ST",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744643324",
            "telephone_number": "918-456-0641",
            "fax_number": "918-456-8886"
        },
        {
            "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": "918-456-8886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEASTERN HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2026-04-06",
        "certification_date": "2026-04-06",
        "status": "A",
        "authorized_official_last_name": "WOODLIFF",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-456-0641",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "OK",
            "license": "2178",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100700680B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TAHLEQUAH HOSPITAL AUTHORITY",
            "code": "4",
            "type": "Former Legal Business 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, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.