NPIMap

Organization Active NPI

Arkansas Verdigris Valley Health Centers, Inc.

Doing business as Coweta Health Center

  • Family Medicine Physician
  • Coweta, OK
National Provider Identifier
1346712072
Registry record updated Apr 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ARKANSAS VERDIGRIS VALLEY HEALTH CENTERS, INC.
Doing business as
Coweta Health Center
Practice address
607 S Broadway
Coweta, OK 74429-5000
Phone
(918) 486-5564
NPI assigned
Dec 19, 2018
Last updated
Apr 21, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2026

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

Authorized official

Name
Sonya L Smith
Title
Ceo
Phone
(918) 483-0111

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

607 S Broadway
Coweta, OK 74429-5000

Mailing address

PO Box 334
Porter, OK 74454-0334
Phone (918) 483-0111

Other names 1

  • Coweta Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070822000520 OK Part B Supplier - Clinic/Group Practice 2961594916 Receives reassigned benefits from 12 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Coweta, OK; Muskogee, OK; Porter, OK
O20190213000480 OK Part A Provider - Federally Qualified Health Center (FQHC) 2961594916 Practice locations: Coweta, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346712072. Details of each certification follow.

Federally qualified health center certification: CCN 371938

Legal name
ARKANSAS VERDIGRIS VALLEY HEALTH CENTERS, INC.
Doing business as
COWETA HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 5, 2019
Last certification
Feb 5, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 9, 2005 in OK
Enrollment address
607 S Broadway
Coweta, OK 74429-5000

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.

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
37D2163065Arkansas Verdigris Valley Health Centers, Inc607 S Broadway, Coweta, OK 74429Certificate of waiverMar 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
Arkansas Verdigris Valley Health Centers Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

201 N 32nd St
Muskogee, OK 74401
Phone (918) 912-2333

619 N Main St
Bldg D
Muskogee, OK 74401
Phone (918) 682-0222

505 S Main St
Tullahassee, OK 74454
Phone (918) 483-0111

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Wade Rousselot Individual Corporate DirectorBoard Member Nov 29, 2018
Sonya Smith Individual W-2 Managing EmployeeCeo Jul 1, 2016 100%
Operational/Managerial ControlCeo Jul 1, 2016 100%
Benjamin T Harmon Individual Corporate DirectorBoard Member Nov 21, 2005
Yolanda K Harmon Individual Corporate OfficerBoard President Dec 28, 2017
Chad E Marshall Individual Corporate OfficerTreasurer Dec 7, 2021
Elizabeth a Acree Individual Corporate OfficerBoard Secretary Dec 28, 2017
Lewis a Parnell Individual Corporate DirectorBoard Member Dec 7, 2021
Shirley M Herring Individual Corporate OfficerVice President Dec 28, 2017
Heath Underwood Individual Corporate DirectorBoard Member Sep 13, 2023
Tyler Lang Individual Corporate DirectorBoard Member Jul 20, 2021
Candy Antu-Ginn Individual Corporate DirectorBoard Member May 9, 2023

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1545177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776729600000",
    "number": "1346712072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 334",
            "city": "PORTER",
            "state": "OK",
            "postal_code": "744540334",
            "telephone_number": "918-483-0111",
            "fax_number": "918-483-4174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 S BROADWAY",
            "city": "COWETA",
            "state": "OK",
            "postal_code": "744295000",
            "telephone_number": "918-486-5564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARKANSAS VERDIGRIS VALLEY HEALTH CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-19",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "SONYA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-483-0111"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coweta Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coweta, OK

Sources for this page

Verify at the official NPI Registry.