NPIMap

Organization Active NPI

Fairfax Medical Facilities, Inc.

  • Federally Qualified Health Center (FQHC)
  • Ponca City, OK
National Provider Identifier
1316747017
Registry record updated Apr 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAIRFAX MEDICAL FACILITIES, INC.
Practice address
122 E Grand Ave
Ponca City, OK 74601-5205
Phone
(580) 203-8270
NPI assigned
Mar 13, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2026

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

Authorized official

Name
Tammy Leeper
Title
Ceo
Phone
(918) 642-3100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

122 E Grand Ave
Ponca City, OK 74601-5205

Mailing address

212 N Main St
Fairfax, OK 74637-3023
Phone (918) 642-3100

Other identifiers 1

IdentifierTypeStateIssuer
200071420MMedicaidOK

Other names 1

  • Ponca City Family Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250703000802 OK Part A Provider - Federally Qualified Health Center (FQHC) 4284663360 Practice locations: Ponca City, OK

Federally qualified health center certification: CCN 371056

Legal name
FAIRFAX MEDICAL FACILITIES INC
Doing business as
PONCA CITY FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 18, 2025
Last certification
Jun 18, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
122 E Grand Ave
Ponca City, OK 74601-5205

Other NPIs with the same Medicare PAC ID 3

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

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
37D2323616Ponca City Family Health122 E Grand Ave, Ponca City, OK 74601Certificate of waiverMay 8, 2027

National Provider Directory

National Provider Directory
Tax ID family
Fairfax Med Facilities Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

301 N 2nd St
Fairfax, OK 74637
Phone (918) 642-3515

160 N Main St
Fairfax, OK 74637

119 W Main St
Hominy, OK 74035
Phone (918) 497-8138

409 N Eastern Ave
Hominy, OK 74035
Phone (918) 885-4640

716 S Highway 77
#A
Newkirk, OK 74647
Phone (580) 362-2555

1717 N 4th St
Ste 101
Ponca City, OK 74601
Phone (580) 767-1777

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AGHIAA

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
Tammy Leeper Individual W-2 Managing EmployeeCeo, Authorized Offical Apr 15, 2025
Robert Howard Individual Corporate OfficerBoard President Sep 17, 2024
Cheryl Carter Individual W-2 Managing EmployeeAd; Jul 19, 2019 50%
Norris Frederick Individual Corporate DirectorBoard Director Feb 15, 2022
Dolley Roland Individual Corporate OfficerBoard Secretary Sep 17, 2024
Jeffery Lockett Individual Corporate OfficerTreasurer Sep 17, 2024
Neal Douglas MC Conaghy Individual Corporate OfficerBoard Vice President May 20, 2025

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1741824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776124800000",
    "number": "1316747017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 N MAIN ST",
            "city": "FAIRFAX",
            "state": "OK",
            "postal_code": "746373023",
            "telephone_number": "918-642-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 E GRAND AVE",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746015205",
            "telephone_number": "580-203-8270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFAX MEDICAL FACILITIES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-13",
        "last_updated": "2026-04-14",
        "certification_date": "2026-04-14",
        "status": "A",
        "authorized_official_last_name": "LEEPER",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-642-3100"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200071420M",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ponca City Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ponca City, OK

Sources for this page

Verify at the official NPI Registry.