NPIMap

Organization Active NPI

AMC Medical Clinic I LLC

Doing business as AMC Medical Clinic LLC

  • Rural Health Clinic/Center
  • Eufaula, OK
National Provider Identifier
1295368587
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
AMC MEDICAL CLINIC I LLC
Doing business as
AMC Medical Clinic LLC
Practice address
218 N Main St
Eufaula, OK 74432-1633
Phone
(918) 689-7705
Fax
(855) 860-5341
NPI assigned
Feb 15, 2020
Last updated
Dec 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2024

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

Authorized official

Name
Monya York
Title
Director Credentialing
Phone
(870) 856-1202

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X
Rural Health Clinic/Center 261QR1300X Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

218 N Main St
Eufaula, OK 74432-1633

Mailing address

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

Other names 1

  • AMC MEDICAL CLINIC LLC Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200401003332 OK Part B Supplier - Clinic/Group Practice 6901235563 Receives reassigned benefits from 9 practitioners
Practice locations: Eufaula, OK
O20200504000783 OK Part A Provider - Rural Health Clinic 6901235563 Practice locations: Eufaula, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295368587. Details of each certification follow.

Rural health clinic certification: CCN 373883

Legal name
AMC MEDICAL CLINIC I LLC
Doing business as
AMC MEDICAL CLINIC LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 30, 2020
Last certification
Jun 30, 2020
Ownership / control type
1C
Organization structure
LLCProprietary
Incorporated
Jan 23, 2020 in OK
Enrollment address
218 N Main St
Eufaula, OK 74432-1633

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
37D2179235AMC Medical Clinic, LLC218 N Main St, Eufaula, OK 74432Certificate of waiverFeb 18, 2028

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/21087/brand/1/csg/1/fhir/r4

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 20, 2026
W-2 Managing EmployeeAd; May 20, 2026
Operational/Managerial ControlSVP of Clinic Division May 20, 2026
Mark Hahn Individual 5% Or Greater Direct Ownership InterestMedical Director May 8, 2025 100%
Tony D James Individual Corporate OfficerCfo May 20, 2026
W-2 Managing EmployeeAd; May 20, 2026
Jared Clifford Individual Corporate OfficerCeo May 8, 2025
W-2 Managing EmployeeAd; May 20, 2026
Monya York Individual W-2 Managing EmployeeDirector Credentialing May 8, 2025
Operational/Managerial ControlDirector Credentialing May 8, 2025
Randi L Davis Individual Corporate DirectorSr Director Clinic Operations May 20, 2026
W-2 Managing EmployeeAd; May 8, 2025
Operational/Managerial ControlSr Director Clinic Operations May 20, 2026
Kasey Crawford Individual Corporate DirectorDirector Clinic Operations Mar 14, 1976
W-2 Managing EmployeeAd; May 20, 2026
Operational/Managerial ControlDirector Clinic Operations May 20, 2026

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1581724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734393600000",
    "number": "1295368587",
    "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": "218 N MAIN ST",
            "city": "EUFAULA",
            "state": "OK",
            "postal_code": "744321633",
            "telephone_number": "918-689-7705",
            "fax_number": "855-860-5341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMC MEDICAL CLINIC I LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-15",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A",
        "authorized_official_last_name": "YORK",
        "authorized_official_first_name": "MONYA",
        "authorized_official_title_or_position": "DIRECTOR CREDENTIALING",
        "authorized_official_telephone_number": "870-856-1202"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AMC MEDICAL CLINIC LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AMC MEDICAL CLINIC LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eufaula, OK

Sources for this page

Verify at the official NPI Registry.