Kiamichi Family Medical Center Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Idabel, OK
NPI 1184633786 · NPPES record last updated Jun 2, 2026
Key facts
- NPI
- 1184633786
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- KIAMICHI FAMILY MEDICAL CENTER INC.
- Practice address
- 403 S Indian Rd
Idabel, OK 74745-5458 - Phone
- (580) 286-6688
- Fax
- (580) 286-6699
- NPI assigned
- Aug 5, 2006
- Organization subpart
- No
Authorized official
- Name
- Amy Gilbreath
- Title
- Ceo
- Phone
- (580) 241-5294
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 3
Related certifications (CCN) 1
Practitioners 12
-
Jamie Bivings, LCSW
-
Tabatha Leforce, APRN
-
Lisa A Baracker, DO
-
Tonya Joy Boles, PAC
-
Bambi A Clay, PA-C
-
Beth Lee Leader, DO
-
Natorrie D'Atra Morris, APRN
-
Tammy Michelle Williams, PA-C
-
John D Lindsey, M.D.
-
Mark Wade Ziegler, DMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 37D1053544 | Kiamichi Family Medical Center, Inc | Certificate of waiver | Oct 12, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OK
Federally qualified health center certification: CCN 371840
- Legal name
- KIAMICHI FAMILY MEDICAL CENTER INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- May 10, 2006
- Last certification
- May 10, 2006
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 8, 2002 in OK
- Enrollment address
- 403 S Indian Rd
Idabel, OK 74745-5458 - Related CCNs
- 371831
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Micheal McConnell |
Corporate Director | Mar 3, 2006 | |
| Deborah Farley |
Corporate Director | Mar 3, 2006 | |
| Patty Skeen |
Corporate Director | Nov 15, 2006 | |
| Scott Rickey |
Corporate Officer |
Jun 1, 2011 | |
| Kenneth Dial |
Corporate Director | Mar 17, 2010 | |
| Stacey Ebert |
Corporate Director | Jun 18, 2014 | |
| James Hamilton |
Corporate Director | Mar 3, 2006 | |
| Amy Gilbreath |
Corporate Director |
Jun 1, 2011 | |
| W-2 Managing Employee | Jan 1, 2003 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040304000870 | OK | Part B Supplier - Clinic/Group Practice | 7315855541 |
Receives reassigned benefits from 15 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Broken Bow, OK; Idabel, OK |
| O20060303000614 | OK | Part a Provider - Federally Qualified Health Center (FQHC) | 7315855541 | Practice locations: Idabel, OK |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
403 S Indian Rd
Idabel, OK 74745-5458
Mailing address
403 S Indian Rd
Idabel, OK 74745-5458
Phone (580) 286-6688
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200003420C | Medicaid | OK |
Other providers in Idabel, OK
- Carol Ann Kerr
- Olga Khudoley
- Kiamchi Youth Services Inc
- Kiamichi Council on Alcohoism and Other Drug Abuse Inc.
- Kiamichi Council on Alcoholism and Or Other Drug Abuse, Inc.
- Kiamichi Family Medical Center Inc.
- Kiamichi Youth Services
- Kristen Clouse DNP, Pmhnp-BC, LLC
- Denise K Kuykendall
- Song Y Lavalais
All providers in Idabel, OK · Federally Qualified Health Center (FQHC) in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 2, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.