FAMILY HEALTH CENTER OF SOUTHERN OKLAHOMA INC (NPI# 1982267910) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982267910 |
| Entity Type | Organization |
| Organization Name | FAMILY HEALTH CENTER OF SOUTHERN OKLAHOMA INC |
| Practice Address |
21 N Main St Kingston OK 73439-6562 |
| Mailing Address |
610 E 24th St Tishomingo OK 73460-3245 |
| Practice Telephone | 5805647885 |
| Mailing Telephone | 5803712343 |
| Mailing Fax Number | 5803713614 |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2019-04-16 |
| Authorized Official Name | TINA JAREE DAVIS (CEO) |
| Authorized Official Telephone | 5803712343 |
| Is Organization Subpart | Y |
| Parent Organization Name | FAMILY HEALTH CENTER OF SOUTHERN OKLAHOMA INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174830665 | Family Health Center of Southern Oklahoma Inc | Clinic/Center | 107 E Post Ave, Coalgate, OK 74538-3004 | 2010-09-07 |
| 1598803942 | Family Health Center of Southern Oklahoma Inc | Clinic/Center | 610 E 24th St, Tishomingo, OK 73460-3245 | 2007-02-01 |
| Street Address |
21 N MAIN ST |
| City | KINGSTON |
| State | OK |
| Zip Code | 73439-6562 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437566213 | Ana Carolina Oliveira Crew | Family Medicine | 21 N Main St, Kingston, OK 73439-6562 | 2014-07-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407489859 | Amanda Griffin | Behavior Technician | 9236 Polvadore Drive, Kingston, OK 73439 | 2020-02-13 |
| 1659837102 | Sheriden Cheyenne Franks | Pharmacist | 7 North Main Street, Kingston, OK 73439 | 2019-02-20 |
| 1275061467 | Ayandeh Health LLC | Nurse Practitioner | 7 N Main Street, Kingston, OK 73439 | 2017-06-01 |
| 1720526437 | Tammy Lynn Williams | Nurse Practitioner | 7 N Main, Kingston, OK 73439 | 2017-02-02 |
| 1053774794 | Tressa Antionette Matchen | Nurse Practitioner | 701 East Hwy 70 Alliance Health Medical Group, Kingston, OK 73439 | 2016-03-31 |
| 1932577277 | Laura Kay Gleaves | Counselor | 717 B Hwy E, Kingston, OK 73439 | 2015-09-03 |
| 1346622099 | Alicia Thompson | Community Health Worker | 400 North East Third, Kingston, OK 73439 | 2015-06-18 |
| 1790188639 | Lakeside Family Medicine | Family Medicine | 714 Hwy 70 E, Kingston, OK 73439 | 2014-10-07 |
| 1518373513 | Dana Boldt Green, M.ed., Lpc, Ncgc-2, PC | Community/Behavioral Health | 8800 Birch St, Kingston, OK 73439 | 2014-07-10 |
| 1205131554 | Marie Morrison Bramlett | Counselor | 400 Ne 3rd St, Kingston, OK 73439 | 2011-01-18 |
| Find all providers in zip 73439 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518585579 | Port Gamble S'klallam Tribe | Clinic/Center | 32014 Little Boston Rd Ne, Kingston, WA 98346-9734 | 2020-07-07 |
| 1952422354 | Luzerne Wyoming County Mh Center #1 | Clinic/Center | 562 Wyoming Ave, Kingston, PA 18704-3721 | 2007-04-03 |
| 1760428650 | Port Gamble S'klallam Tribe | Clinic/Center | 32014 Little Boston Rd Ne, Kingston, WA 98346-9734 | 2006-06-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902404965 | Variety Care, Inc. | Clinic/Center | 201 Ne 50th St Ste 117, Oklahoma City, OK 73105-1811 | 2020-10-13 |
| 1699318550 | Community Health Center of Northeast Oklahoma, Inc. | Clinic/Center | 220 S Mickey Mantle Blvd, Commerce, OK 74339-2924 | 2019-10-23 |
| 1013567940 | Community Health Center of Southeast Kansas, Inc. | Clinic/Center | 7 S 1st St, Wyandotte, OK 74370-2268 | 2019-09-12 |
| 1013569961 | Community Health Connection, Inc. | Clinic/Center | 13702 E 46th Pl, Tulsa, OK 74134-5919 | 2019-07-11 |
| 1184286726 | Central Oklahoma Family Medical Center, Inc | Clinic/Center | 302 W Smith Street, Stratford, OK 74872-4648 | 2019-07-03 |
| 1982263752 | Shortgrass Community Health Center, Inc | Clinic/Center | 211 East Broadway, Altus, OK 73521 | 2019-06-06 |
| 1265902589 | Community Health Center of Northeast Oklahoma | Clinic/Center | 244 S Scraper Suite D, Vinita, OK 74301-3716 | 2018-11-29 |
| 1063988673 | Central Oklahoma Family Medical Center, Inc | Clinic/Center | 905 Colony Drive Bldg, Ada, OK 74820 | 2018-10-22 |
| 1306352547 | Variety Care, Inc. | Clinic/Center | 721 W Britton Rd, Oklahoma City, OK 73114-2909 | 2017-12-26 |
| 1568976991 | Arkansas Verdigris Valley Health Centers,inc. | Clinic/Center | 201 North 32nd Street, Muskogee, OK 74401-2104 | 2017-11-21 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.