| Eastside Clinic | |
|
22408 Highway 51 Tahlequah OK 74464-2058 | |
| (918) 456-6250 | |
| (918) 456-4080 |
| Full Name | Eastside Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 22408 Highway 51, Tahlequah, Oklahoma |
| Authorized Official Name and Position | James Mark Seratt (OWNER/DOCTOR) |
| Authorized Official Contact | 9184566250 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastside Clinic Po Box 59 Tahlequah OK 74465-0059 Ph: (918) 456-6250 | Eastside Clinic 22408 Highway 51 Tahlequah OK 74464-2058 Ph: (918) 456-6250 |
| NPI Number | 1023295193 |
|---|---|
| Provider Enumeration Date | 01/30/2008 |
| Last Update Date | 07/28/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023295193 | NPI | - | NPPES |
| 4111208 | Other | OK | AETNA |
| C95468 | Other | OK | UPIN |
| 110118510A | Medicaid | OK | |
| 445569081002 | Other | OK | BLUECROSS AND BLUESHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 15674 (Oklahoma) | Primary |
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