Cah Acquisition Company 12 LLC
Organization Active NPI Rural Health Clinic/Center · Fairfax, OK
NPI 1306145339 · NPPES record last updated Jul 16, 2018
Key facts
- NPI
- 1306145339
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 2274 (OK)
- Legal business name
- CAH ACQUISITION COMPANY 12 LLC
- Practice address
- 40 Hospital Rd
Fairfax, OK 74637 - Phone
- (918) 642-8827
- Fax
- (918) 642-3298
- NPI assigned
- Mar 16, 2011
- Organization subpart
- Yes
- Parent organization (as reported)
- CAH ACQUISITION COMPANY 12 LLC
Authorized official
- Name
- Tina J Steele
- Title
- Ceo
- Phone
- (918) 642-3291
Parent organization (reported in NPPES) 1
Change of ownership 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 37D2178805 | Fairfax Rural Health Clinic | Certificate of waiver | Feb 9, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Mar 20, 2020 | Change of Ownership |
Rural Wellness Fairfax Clinic |
National Provider Directory
- Part of
- Cah Acquisition Company 12 LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 2274 | OK | Yes |
Addresses
Primary practice location
40 Hospital Rd
Fairfax, OK 74637
Mailing address
40 Hospital Rd
Fairfax, OK 74637-5084
Phone (918) 642-3291
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200311270C | Medicaid | OK |
Other names
- Fairfax Rural Health Clinic
Other providers in Fairfax, OK
- Michael S Ben
- Sarah Christine Ben
- Sarah Camryn Bese
- Neal Ross Brockbank
- Cah Acquisition Company 12 LLC
- Leslie C Christopher
- Deanna J. Cummings
- Fairfax Behavioral Health and Memory Care Community, LLC
- Fairfax Dental Office PLLC
- Fairfax Healthcare Properties, LLC
All providers in Fairfax, OK · Rural 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 Jul 16, 2018. 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.