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Roger Mills County Hospital Authority

Organization Active NPI Rural Health Clinic/Center · Cheyenne, OK

NPI 1407950447 · NPPES record last updated Dec 5, 2017

Key facts

NPI
1407950447
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
ROGER MILLS COUNTY HOSPITAL AUTHORITY
Practice address
101 FK Buster Ave
Cheyenne, OK 73628-0490
Phone
(580) 497-3333
Fax
(580) 497-2778
NPI assigned
Sep 11, 2006
Organization subpart
Yes
Parent organization (as reported)
ROGER MILLS COUNTY HOSPITAL AUTHORITY

Authorized official

Name
Ms. Cynthia E Duncan
Title
Ceo
Phone
(580) 497-3336

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.

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 1

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

Other NPIs with the same Medicare PAC ID 2

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

Corporate family (same tax ID) 2

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

Facilities connected through Provider of Services related, parent or unit certification numbers.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 7

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in OK

Rural health clinic certification: CCN 373999

Legal name
ROGER MILLS COUNTY HOSPITAL AUTHORITY
Doing business as
BUSTER RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 16, 1994
Last certification
Mar 31, 2021
Ownership / control type
Non-profit – church related
Organization structure
Other · Non-profit
Enrollment address
101 FK Buster Ave
Cheyenne, OK 73628-0490
Related CCNs
371303

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Cynthia E Duncan
Individual 		Corporate Officer
Ceo		 Jul 12, 2006 100%
W-2 Managing Employee
Ceo		 Jul 21, 2015 100%
Randy O'Neal
Individual 		Corporate Director May 10, 2021
Janet Barton
Individual 		W-2 Managing Employee
Ceo		 Jul 21, 2015 100%
Operational/Managerial Control
Office Manager		 Dec 29, 2015 100%
Roger Mills County Hospital Authority
Organization · Cheyenne, OK 		Operational/Managerial Control Mar 14, 1994

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Roger Mills Memorial Hospital
Cheyenne, OK · CCN 371303		 Hospital Operational/Managerial Control Apr 1, 1999
Roger Mills Memorial Hospital
Cheyenne, OK · CCN 37Z303		 Hospital Operational/Managerial Control Apr 1, 1999

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20080910000682 OK Part a Provider - Rural Health Clinic 7113827403 Practice locations: Cheyenne, OK

National Provider Directory

Tax ID family
Roger Mills Memorial Ho (3 organizations share this tax ID)
Part of
Roger Mills Memorial Ho

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

101 FK Buster Ave
Cheyenne, OK 73628-0490

Mailing address

PO Box 490
Cheyenne, OK 73628-0490
Phone (580) 497-3333

Other identifiers

IdentifierTypeStateIssuer
100699820EMedicaidOK
100699820FMedicaidOK

Other providers in Cheyenne, OK

All providers in Cheyenne, OK · Rural Health Clinic/Center in Oklahoma

Sources for this page

Verify at the official NPI Registry.