NPIMap

Organization Active NPI

Kiamichi Family Medical Center Inc.

  • Federally Qualified Health Center (FQHC)
  • Idabel, OK
National Provider Identifier
1184633786
Registry record updated Jun 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
Jun 2, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amy Gilbreath
Title
Ceo
Phone
(580) 241-5294

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184633786. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Jan 8, 2002 in OK
Enrollment address
403 S Indian Rd
Idabel, OK 74745-5458
Related CCNs
371831

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D1053544Kiamichi Family Medical Center, Inc403 S Indian Rd, Idabel, OK 74745Certificate of waiverOct 12, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Micheal McConnell Individual Corporate Director Mar 3, 2006
Deborah Farley Individual Corporate Director Mar 3, 2006
Patty Skeen Individual Corporate Director Nov 15, 2006
Scott Rickey Individual Corporate OfficerChief Financial Officer Jun 1, 2011
Kenneth Dial Individual Corporate Director Mar 17, 2010
Stacey Ebert Individual Corporate Director Jun 18, 2014
James Hamilton Individual Corporate Director Mar 3, 2006
Amy Gilbreath Individual Corporate DirectorChief Executive Officer Jun 1, 2011
W-2 Managing Employee Jan 1, 2003

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780358400000",
    "number": "1184633786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 S INDIAN RD",
            "city": "IDABEL",
            "state": "OK",
            "postal_code": "747455458",
            "telephone_number": "580-286-6688",
            "fax_number": "580-286-6699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 S INDIAN RD",
            "city": "IDABEL",
            "state": "OK",
            "postal_code": "747455458",
            "telephone_number": "580-286-6688",
            "fax_number": "580-286-6699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIAMICHI FAMILY MEDICAL CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A",
        "authorized_official_last_name": "GILBREATH",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "580-241-5294"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idabel, OK

Sources for this page

Verify at the official NPI Registry.