Clinton Indian Health Center
Organization Active NPI Federal Public Health Clinic/Center · Clinton, OK
NPI 1205923448 · NPPES record last updated Nov 26, 2019
Key facts
- NPI
- 1205923448
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federal Public Health Clinic/Center 261QP0904X
- Legal business name
- CLINTON INDIAN HEALTH CENTER
- Practice address
- 10321 N 2274 Rd
Clinton, OK 73601-7521 - Phone
- (580) 331-3404
- Fax
- (580) 331-3565
- NPI assigned
- Oct 9, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- LAWTON INDIAN HOSPITAL
Authorized official
- Name
- Mr. Joe Bryant
- Title
- Area Director
- Phone
- (580) 331-3315
Other NPIs on the same Medicare enrollment 5
Corporate family (same tax ID) 8
Member of 1
Practitioners 170
-
Rafel Alvarez, D.O.
-
Stephen Arthur Back, D.O.
-
Damon Lee Brooks, D.O.
-
Nicholas Bull, D.O.
-
Dustin Cheney, D.O.
-
Bo Yon Choi, D.O.
-
Joseph Martin Eble, M.D.
-
Eugenio Erquiaga, M.D.
-
Kyle Griffin Flowers, D.O.
-
Jeremy Scott Fullingim, D.O.
-
Jasmine R Gaddy, M.D.
-
Shawn D Grant, MD
-
Jessica Greene, O.D.
-
Trina Dea Jones, O.D.
-
Julia Dry Knarreborg, M.D.
-
Jeff Hu Lee, D.O.
-
Peter James Mostert, D.O.
-
Robert Gene Moult, D.O.
-
Ralph Noah, M.D.
Affiliated clinicians 163
-
Bobby Ray Abernathy, D.O.
-
Zubair Ahmad, M.D.
-
Laura L Alexander, O.D.
-
Solomon Ali, M.D.
-
Srilatha R Ayirala, M.D.
-
Angela Battese, APRN FNP-C
-
John Bear, LCSW
-
Michelle Marie Beshaw, PA-C
-
Michael Blose, DO
-
Kelly Boucher, O.D
-
Grace Brzozowski, PA-C
-
Mary Ann Cameron, MD
-
Celena Cardenaz, FNP-C
-
Joshua P Carey, M.D.
-
Marc Anthony Clanton, PSY.D.
-
Marsha Cobell-Moore, MSW LCSW
-
James Doyle Coffey, O.D.
Medicare Care Compare: Hospital
- Listed as
- Lawton Indian Hospital
- Type
- Acute Care Hospitals
- Ownership
- Tribal
- Medicare certification status
- Active
- Emergency services
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, OK
Hospital certification: CCN 370170
- Legal name
- LAWTON INDIAN HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Mar 9, 1977
- Last certification
- May 28, 2025
- Beds
- 26
- Ownership / control type
- Tribal
- Organization structure
- Other · Non-profit
- Enrollment address
- 1515 NE Lawrie Tatum Rd
Lawton, OK 73507-3002 - Hospital subgroups
- General, Other
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Greggory J Woitte |
Corporate Officer |
Feb 1, 2025 | |
| W-2 Managing Employee |
Feb 1, 2025 | ||
| Brian Wren |
Corporate Officer |
Aug 14, 2023 | |
| W-2 Managing Employee |
Aug 14, 2023 | ||
| Travis E Watts |
Corporate Director |
Jul 1, 2019 | |
| W-2 Managing Employee |
Aug 12, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040121000506 | TX | Part B Supplier - Clinic/Group Practice | 2163324237 |
Receives reassigned benefits from 160 practitioners Practice locations: Clinton, OK |
| O20070712000757 | OK | Part a Provider - Hospital | 6406800234 |
5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Wewoka, OK; Watonga, OK; Pawnee, OK; Lawton, OK; Clinton, OK; El Reno, OK; Anadarko, OK; Carnegie, OK |
National Provider Directory
- Tax ID family
- Lawton IHS Pharmacy
- Part of
- Lawton IHS Pharmacy
Locations
3625 NW 56th St
Oklahoma City, OK 73112
Phone (580) 331-3399
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federal Public Health Clinic/Center | 261QP0904X | Yes |
Addresses
Primary practice location
10321 N 2274 Rd
Clinton, OK 73601-7521
Mailing address
RR 1 Box 3060
Clinton, OK 73601-9303
Phone (580) 331-3404
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200119820A | Medicaid | OK |
Other names
- CLINTON INDIAN HEALTH CENTER
Other providers in Clinton, OK
- Clinton Home Health & Hospice, LLC
- Clinton Hospital Authority
- Clinton Hospital Authority
- Clinton Hospital Authority
- Clinton Hospital Authority
- Clinton Indian Health Center
- Clinton Nursing and Rehab LLC
- Clinton Nursing Center, LLC
- Clinton Public Schools
- Clinton Therapy & Living Center, LLC
All providers in Clinton, OK · Federal Public Health Clinic/Center in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 26, 2019. 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.