NPIMap

Organization Active NPI

East Central Oklahoma Family Health Center, Inc.

Doing business as East Central Oklahoma Family Health Center, Inc. Pharmacy

  • Federally Qualified Health Center (FQHC)
  • Wetumka, OK
National Provider Identifier
1316196546
Registry record updated Jul 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC.
Doing business as
East Central Oklahoma Family Health Center, Inc.
East Central Oklahoma Family Health Center, Inc. Pharmacy
Practice address
109 S Main St
Wetumka, OK 74883-4015
Phone
(405) 452-5400
Fax
(405) 452-3379
NPI assigned
Sep 11, 2008
Last updated
Jul 17, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 17, 2025

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

Authorized official

Name
Donna Dyer
Title
Ceo
Phone
(405) 452-3151

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 40-5941 OK

Addresses

Primary practice location

109 S Main St
Wetumka, OK 74883-4015

Mailing address

PO Box 236
Wetumka, OK 74883-0236
Phone (405) 452-5400

Other identifiers 2

IdentifierTypeStateIssuer
2134967OtherPK
200235450AMedicaidOK

Other names 2

  • East Central Oklahoma Family Health Center, Inc. Doing business as
  • East Central Oklahoma Family Health Center, Inc. Pharmacy Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20081118000589 OK Part A Provider - Federally Qualified Health Center (FQHC) 3779643994 Practice locations: Wetumka, OK
O20090330000363 OK Part B Supplier - Clinic/Group Practice 3779643994 Receives reassigned benefits from 11 practitioners
3 other NPIs on this enrollment
Practice locations: Henryetta, OK; Wetumka, OK; Wewoka, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316196546. Details of each certification follow.

Federally qualified health center certification: CCN 371849

Legal name
EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 14, 2009
Last certification
Jan 14, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 22, 2003 in OK
Enrollment address
109 S Main St
Wetumka, OK 74883-4015

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Part of
East CTRL Ok Fam HLTH Ctr I

Locations

104 E Shurden Industrial Blvd
Henryetta, OK 74437
Phone (918) 652-9614

1102 W Main St
Henryetta, OK 74437
Phone (918) 652-9614

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Tony Fish Individual Corporate DirectorBoard Member Jul 1, 2009
Kimberly Meeks Individual Corporate DirectorBoard Member Oct 13, 2008
Brent McGee Individual Corporate DirectorBoard Member Nov 13, 2008
Vernon Stout Individual Corporate DirectorBoard Member Oct 13, 2008
Michael Lindley Individual Corporate OfficerBoard Member Dec 16, 2021
Darin Hebert Individual Corporate OfficerBoard Member Sep 16, 2021
Gisela Williams Individual Corporate OfficerBoard Member Mar 23, 2017
Donna Dyer Individual W-2 Managing EmployeeCeo Oct 13, 2008
Operational/Managerial ControlCeo Oct 13, 2008 100%
Vic Woods Individual Corporate OfficerBoard Member Nov 19, 2020

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
East Central Oklahoma Family Health Center, Inc.Henryetta, OK, CCN 371886 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2012
East Central Oklahoma Family Health Center, Inc. - WewokaWewoka, OK, CCN 371911 Federally qualified health center Operational/Managerial Control Nov 16, 2015

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1221091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752710400000",
    "number": "1316196546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 236",
            "city": "WETUMKA",
            "state": "OK",
            "postal_code": "748830236",
            "telephone_number": "405-452-5400",
            "fax_number": "405-452-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 S MAIN ST",
            "city": "WETUMKA",
            "state": "OK",
            "postal_code": "748834015",
            "telephone_number": "405-452-5400",
            "fax_number": "405-452-3379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC.",
        "enumeration_date": "2008-09-11",
        "last_updated": "2025-07-17",
        "certification_date": "2025-07-17",
        "status": "A",
        "authorized_official_last_name": "DYER",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "405-452-3151"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OK",
            "license": "40-5941",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2134967",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200235450A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Central Oklahoma Family Health Center, Inc.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "East Central Oklahoma Family Health Center, Inc. Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wetumka, OK

Sources for this page

Verify at the official NPI Registry.