NPIMap

Organization Active NPI

Access Medical Clinic LLC

  • Rural Health Clinic/Center
  • Tahlequah, OK
National Provider Identifier
1194586461
Registry record updated Oct 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ACCESS MEDICAL CLINIC LLC
Practice address
709 E Downing St
Tahlequah, OK 74464-3213
Phone
(918) 458-9444
Fax
(918) 458-9445
NPI assigned
Jan 23, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2024

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

Authorized official

Name
Monya York
Title
Controller
Phone
(870) 856-1202

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

709 E Downing St
Tahlequah, OK 74464-3213

Mailing address

4196 Highway 62 412 Ste a
Hardy, AR 72542-8002

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240401001442 OK Part A Provider - Rural Health Clinic 1951721802 Practice locations: Tahlequah, OK

Rural health clinic certification: CCN 373910

Legal name
ACCESS MEDICAL CLINIC LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 29, 2024
Last certification
Aug 29, 2024
Ownership / control type
1A
Organization structure
LLCProprietary
Incorporated
Jun 12, 2020 in TN
Enrollment address
709 E Downing St
Tahlequah, OK 74464-3213

Other NPIs with the same Medicare PAC ID 10

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

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
37D2298456Access Medical Clinic LLC709 E Downing St, Tahlequah, OK 74464Certificate of waiverFeb 1, 2028

National Provider Directory

National Provider Directory
Tax ID family
Access Medical Clinic11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

49 Highway 62 412
Ash Flat, AR 72513
Phone (573) 718-2570

709 E Downing St
Tahlequah, OK 74464
Phone (918) 207-0773

1700 W FM 700
Ste B
Big Spring, TX 79720
Phone (432) 264-1900

1700 W FM 700
Ste A
Big Spring, TX 79720
Phone (432) 264-1900

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Howard Freeman Individual Corporate DirectorSVP of Clinic Division May 19, 2026
W-2 Managing EmployeeAd; May 19, 2026
Operational/Managerial ControlSVP of Clinic Division May 19, 2026
Mark Hahn Individual 5% Or Greater Direct Ownership InterestMedical Director May 8, 2025
Corporate OfficerMedical Director May 8, 2025
Tony D James Individual Corporate OfficerCfo May 19, 2026
W-2 Managing EmployeeAd; May 19, 2026
Jared Clifford Individual Corporate OfficerCeo May 8, 2025
W-2 Managing EmployeeAd; May 19, 2026
Monya York Individual Corporate DirectorDirector Credentialing May 8, 2025
W-2 Managing EmployeeDirector Credentialing Jul 17, 2017
Randi L Davis Individual Corporate DirectorSr Director Clinic Operations May 19, 2026
W-2 Managing EmployeeDirector of Provider Mgmnt May 8, 2025
Operational/Managerial ControlSr Director Clinic Operations May 19, 2026
Kasey Crawford Individual Corporate DirectorDirector Clinic Operations May 19, 2026
W-2 Managing EmployeeAd; May 19, 2026
Operational/Managerial ControlDirector Clinic Operations May 19, 2026

Owners & managing parties with NPI records 2

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

  • Randi L Davis, APRN
    • Family Nurse Practitioner
    • Bay, AR
    • NPI 1740622497

    Corporate Director, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership
  • Mark S Hahn, DO
    • Family Medicine Physician
    • Caraway, AR
    • NPI 1609895911

    5% Or Greater Direct Ownership Interest, Corporate Officer

    CMS ownership

NPI Registry JSON

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

{
    "created_epoch": "1705968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728864000000",
    "number": "1194586461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4196 HIGHWAY 62 412 STE A",
            "city": "HARDY",
            "state": "AR",
            "postal_code": "725428002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 E DOWNING ST",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744643213",
            "telephone_number": "918-458-9444",
            "fax_number": "918-458-9445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACCESS MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-23",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A",
        "authorized_official_last_name": "YORK",
        "authorized_official_first_name": "MONYA",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "870-856-1202"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tahlequah, OK

Sources for this page

Verify at the official NPI Registry.