NPIMap

Williams Medical Group Practice, LLC

Organization Active NPI Rural Health Clinic/Center · Garden City, KS

NPI 1104496942 · NPPES record last updated Feb 24, 2023

Key facts

NPI
1104496942
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
WILLIAMS MEDICAL GROUP PRACTICE, LLC
Practice address
1021 Fleming St
Garden City, KS 67846-6269
Phone
(620) 277-2010
NPI assigned
Jun 24, 2021
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 3

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
17D2215035Xpress Wellness Urgent Care
1021 Fleming St, Garden City, KS 67846		Certificate of waiverFeb 25, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in KS

Rural health clinic certification: CCN 703816

Legal name
WILLIAMS MEDICAL GROUP PRACTICE, LLC
Doing business as
XPRESS WELLNESS URGENT CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 7, 2021
Last certification
Oct 7, 2021
Ownership / control type
1B
Organization structure
LLC · Proprietary
Enrollment address
1021 Fleming St
Garden City, KS 67846-6269

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 · Oklahoma City, OK
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
Cmo		 Nov 1, 2022 100%
W-2 Managing Employee
MD;		 Nov 1, 2022 100%

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20210707003735 KS Part a Provider - Rural Health Clinic 3375832157 Practice locations: Garden City, KS

National Provider Directory

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

Locations

1675 12th Ave NW
Ardmore, OK 73401
Phone (580) 798-0234

220 S Van Buren St
Enid, OK 73703
Phone (580) 234-9355

550 W Shawnee St
Muskogee, OK 74401
Phone (908) 910-5186

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207Q00000X
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

1021 Fleming St
Garden City, KS 67846-6269

Mailing address

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

Other names

  • Xpress Wellness Urgent Care Doing business as

Other providers in Garden City, KS

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

Sources for this page

Verify at the official NPI Registry.