NPIMap

Organization Active NPI

Southeastern Oklahoma Family Services, Inc

  • Rural Health Clinic/Center
  • Checotah, OK
National Provider Identifier
1255648580
Registry record updated Oct 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SOUTHEASTERN OKLAHOMA FAMILY SERVICES, INC
Practice address
113653 Old Highway 69
Checotah, OK 74426-8802
Phone
(580) 565-4235
NPI assigned
Sep 8, 2010
Last updated
Oct 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2025

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

Authorized official

Name
Bre'Yon James
Title
Director of Operations
Phone
(918) 490-1352

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

113653 Old Highway 69
Checotah, OK 74426-8802

Mailing address

PO Box 1709
Kingston, OK 73439-1709
Phone (580) 564-7374

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20091111000232 OK Part A Provider - Rural Health Clinic 4284772328 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Checotah, OK
O20120111000121 OK Part B Supplier - Clinic/Group Practice 4284772328 Receives reassigned benefits from 3 practitioners
6 other NPIs on this enrollment
Practice locations: Madill, OK; Norman, OK; McAlester, OK; Kingston, OK; Durant, OK; Checotah, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255648580. Details of each certification follow.

Rural health clinic certification: CCN 373878

Legal name
SOUTHEASTERN OKLAHOMA FAMILY SERVICES, INC.
Doing business as
LAKESIDE RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 15, 2011
Last certification
Aug 2, 2018
Ownership / control type
1B
Organization structure
CorporationNon-profit
Incorporated
Dec 1, 2000 in OK
Enrollment address
113653 Old Highway 69
Checotah, OK 74426-8802

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

39 E Foley
Eufaula, OK 74432

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Milton Evans Individual 5% Or Greater Direct Ownership Interest Dec 1, 2000 100%
OtherChairman of the Board May 1, 2018
Felicia Pearce Individual W-2 Managing EmployeeCeo Mar 23, 2023 100%
Ber'Yon James Individual Corporate DirectorDirector of Operations Mar 23, 2023
Jean Ingram Individual OtherSecretary May 1, 2018

Practitioners & affiliated clinicians

Practitioners 5

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": "1283904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759968000000",
    "number": "1255648580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1709",
            "city": "KINGSTON",
            "state": "OK",
            "postal_code": "734391709",
            "telephone_number": "580-564-7374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113653 OLD HIGHWAY 69",
            "city": "CHECOTAH",
            "state": "OK",
            "postal_code": "744268802",
            "telephone_number": "580-565-4235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN OKLAHOMA FAMILY SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-08",
        "last_updated": "2025-10-09",
        "certification_date": "2025-10-09",
        "status": "A",
        "authorized_official_last_name": "JAMES",
        "authorized_official_first_name": "BRE'YON",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "918-490-1352"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Checotah, OK

Sources for this page

Verify at the official NPI Registry.