NPIMap

Organization Active NPI

Southeastern Oklahoma Family Services, Inc.

  • Rural Health Clinic/Center
  • Eufuala, OK
National Provider Identifier
1447587787
Registry record updated Nov 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SOUTHEASTERN OKLAHOMA FAMILY SERVICES, INC.
Practice address
39 East Foley Ave
Eufuala, OK 74432-2805
Phone
(580) 371-3672
Fax
(580) 371-3651
NPI assigned
Nov 6, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2009

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

Authorized official

Name
Virginia Ragan
Title
Director of Operations
Phone
(580) 371-3672

Specialties & licenses 1

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

Addresses

Primary practice location

39 East Foley Ave
Eufuala, OK 74432-2805

Mailing address

39 East Foley Ave
Eufuala, OK 74432-2805

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20091111000232 OK Part A Provider - Rural Health Clinic 4284772328 1 other NPI on this enrollment
Practice locations: Checotah, OK
O20120111000121 OK Part B Supplier - Clinic/Group Practice 4284772328 Receives reassigned benefits from 3 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Madill, OK; Norman, OK; McAlester, OK; Kingston, OK; Durant, OK; Checotah, OK

Rural health clinic certification: CCN 373878

Legal name
SOUTHEASTERN OKLAHOMA FAMILY SERVICES, INC.
Doing business as
LAKESIDE RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 15, 2011
Last certification
Aug 2, 2018
Ownership / control type
1B
Organization structure
CorporationNon-profit
Incorporated
Dec 1, 2000 in OK
Enrollment address
113653 Old Highway 69
Checotah, OK 74426-8802

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 6

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
37D2267887Lakeside Rural Health Clinic113653 Old Hwy 69, Checotah, OK 74426Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

39 E Foley Ave
Eufuala, OK 74432

Ownership & related parties

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
Milton Evans Individual 5% Or Greater Direct Ownership Interest Dec 1, 2000 100%
OtherChairman of the Board May 1, 2018
Felicia Pearce Individual W-2 Managing EmployeeCeo Mar 23, 2023 100%
Ber'Yon James Individual Corporate DirectorDirector of Operations Mar 23, 2023
Jean Ingram Individual OtherSecretary May 1, 2018

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1257465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257465600000",
    "number": "1447587787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 EAST FOLEY AVE",
            "city": "EUFUALA",
            "state": "OK",
            "postal_code": "744322805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 EAST FOLEY AVE",
            "city": "EUFUALA",
            "state": "OK",
            "postal_code": "744322805",
            "telephone_number": "580-371-3672",
            "fax_number": "580-371-3651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN OKLAHOMA FAMILY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-06",
        "last_updated": "2009-11-06",
        "status": "A",
        "authorized_official_last_name": "RAGAN",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "580-371-3672"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.