Cah Acquisition Company 12 LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

2274 Issued in OK

Legal business name

CAH ACQUISITION COMPANY 12 LLC

Doing business as

Fairfax Rural Health Clinic

Practice address

40 Hospital Rd
Fairfax, OK 74637

Phone

(918) 642-8827

Fax

(918) 642-3298

NPI assigned

Mar 16, 2011

Last updated

Jul 16, 2018By the provider in NPPES

Organization subpart

Yes

Parent organization

CAH ACQUISITION COMPANY 12 LLCAs reported in NPPES

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

Authorized official

Name

Tina J Steele

Title

Ceo

Phone

(918) 642-3291

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Fairfax Rural Health Clinic Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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

CLIA laboratory certificates

Part of

Cah Acquisition Company 12 LLC

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Rural Wellness Fairfax Inc

  dba Rural Wellness Fairfax Clinic

  • Rural Health Clinic/Center
  • Fairfax, OK
  • NPI 1790314466

  Sold to, 2020-03-20

  CMS change of ownership

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Cah Acquisition Company 12 LLC

  dba Fairfax Community Hospital

  • Critical Access Hospital
  • Fairfax, OK
  • NPI 1134451396
  NPPES parent name

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

{
    "created_epoch": "1300233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531699200000",
    "number": "1306145339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 HOSPITAL RD",
            "city": "FAIRFAX",
            "state": "OK",
            "postal_code": "746375084",
            "telephone_number": "918-642-3291",
            "fax_number": "918-642-3694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 HOSPITAL RD",
            "city": "FAIRFAX",
            "state": "OK",
            "postal_code": "74637",
            "telephone_number": "918-642-8827",
            "fax_number": "918-642-3298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAH ACQUISITION COMPANY 12 LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAH ACQUISITION COMPANY 12 LLC",
        "enumeration_date": "2011-03-16",
        "last_updated": "2018-07-16",
        "status": "A",
        "authorized_official_last_name": "STEELE",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-642-3291"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "OK",
            "license": "2274",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200311270C",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairfax Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fairfax Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael S Ben, D.D.S.
• Sarah Christine Ben, PA-C
• Sarah Camryn Bese
• Neal Ross Brockbank, D.O.
• Cah Acquisition Company 12 LLC (Fairfax Community Hospital)
• Leslie C Christopher, DDS
• Deanna J. Cummings, PA-C
• Fairfax Behavioral Health and Memory Care Community, LLC
• Fairfax Dental Office PLLC
• Fairfax Healthcare Properties, LLC (Fairfax Home Health)

• Rural Health Clinic/Center in Fairfax, OK
• Providers in Fairfax, OK by specialty
• Rural Health Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.