NPIMap

Williams Medical Group Practice, LLC

Organization Active NPI Rural Health Clinic/Center · Haysville, KS

NPI 1083398267 · NPPES record last updated Jun 9, 2023

Key facts

NPI
1083398267
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
WILLIAMS MEDICAL GROUP PRACTICE, LLC
Practice address
7107 S Meridian St
Haysville, KS 67060-7678
Phone
(405) 445-1210
NPI assigned
Jun 9, 2023
Organization subpart
No

Authorized official

Name
Grant Asay
Title
Ceo
Phone
(405) 445-1210

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Tony R Hill, DO Emergency Medical Services (Emergency Medicine) Physician · Broken Arrow, OK · NPI 1295723245
    CMS ownership 5% OR GREATER DIRECT OWNERSHIP INTEREST · CORPORATE OFFICER · W-2 MANAGING EMPLOYEE
  • Joseph Michael Moore, MD Internal Medicine Physician · Tulsa, OK · NPI 1104853142
    CMS ownership 5% OR GREATER DIRECT OWNERSHIP INTEREST

Corporate family (same tax ID) 35

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

View all 35

Facilities with the same owner 46

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 46

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
17D2285890Xpress Wellness Urgent Care
7107 S Meridian St, Haysville, KS 67060		Certificate of waiverSep 12, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled in KS

Rural health clinic certification: CCN 703817

Legal name
WILLIAMS MEDICAL GROUP PRACTICE, LLC
Doing business as
XPRESS WELLNESS URGENT CARE
Organization structure
Corporation · Proprietary
Enrollment address
7107 S Meridian St
Haysville, KS 67060-7678

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Joseph M Moore
Individual 		5% Or Greater Direct Ownership Interest
MD		 Aug 21, 2023 49%
Xpress Wellness LLC
Organization · Dallas, TX
Management services company 		Operational/Managerial Control Jul 20, 2018
Tony Hill
Individual 		5% Or Greater Direct Ownership Interest
D.O./Cmo		 Aug 21, 2023 51%
Corporate Officer
Chief Medical Officer		 Nov 1, 2022
W-2 Managing Employee
MD;		 Nov 1, 2022

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20230921003965 KS Part a Provider - Rural Health Clinic 3375832157 Practice locations: Haysville, KS

National Provider Directory

Tax ID family
Williams Medical Group Practice LLC (36 organizations share this tax ID)

Locations

231 S Andover Rd
Andover, KS 67002
Phone (316) 733-9355

1021 Fleming St
Garden City, KS 67846
Phone (620) 277-2010

6744 NW Cache Rd
Lawton, OK 73505
Phone (580) 536-9355

1327 Oklahoma Ave
Woodward, OK 73801
Phone (580) 254-2377

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

7107 S Meridian St
Haysville, KS 67060-7678

Mailing address

701 Cedar Lake Blvd Ste 120
Oklahoma City, OK 73114-7815
Phone (405) 445-1210

Other names

  • Xpress Wellness Doing business as

Other providers in Haysville, KS

All providers in Haysville, KS · Rural Health Clinic/Center in Kansas

Sources for this page

Verify at the official NPI Registry.