| Tahlequah Ent | |
|
1203 E Ross Byp Tahlequah OK 74464-4133 | |
| (918) 453-9002 | |
| (918) 453-0328 |
| Full Name | Tahlequah Ent |
|---|---|
| Speciality | Clinic/Center |
| Location | 1203 E Ross Byp, Tahlequah, Oklahoma |
| Authorized Official Name and Position | Scott Rosenthal (CEO) |
| Authorized Official Contact | 9187723390 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tahlequah Ent Po Box 751 Hulbert OK 74441-0751 Ph: (918) 772-3390 | Tahlequah Ent 1203 E Ross Byp Tahlequah OK 74464-4133 Ph: (918) 453-9002 |
| NPI Number | 1073164125 |
|---|---|
| Provider Enumeration Date | 09/20/2019 |
| Last Update Date | 06/09/2020 |
| Medicare PECOS PAC ID | 3678482635 |
|---|---|
| Medicare Enrollment ID | O20191007000962 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073164125 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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