NPIMap

Organization Active NPI

Sovereign Family Clinic, LLC

Doing business as Sovereign Family Practice Clinic

  • Clinic/Center
  • Ada, OK
National Provider Identifier
1538450689
Registry record updated Jun 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
SOVEREIGN FAMILY CLINIC, LLC
Doing business as
Sovereign Family Practice Clinic
Practice address
1007 N Country Club Rd
Ada, OK 74820-2847
Phone
(580) 421-8700
Fax
(580) 421-8785
NPI assigned
Apr 25, 2011
Last updated
Jun 18, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2015

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

Authorized official

Name
Mr. Chris M Anoatubby
Title
President, Sovereign
Phone
(580) 272-5160

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1007 N Country Club Rd
Ada, OK 74820-2847

Mailing address

1007 N Country Club Rd
Ada, OK 74820-2847
Phone (580) 421-8700

Other names 1

  • Sovereign Family Practice Clinic Doing business as

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
37D2024679Sovereign Family Practice Clinic1007 N Country Club Road, Ada, OK 74820Certificate of waiverAug 15, 2027

National Provider Directory

National Provider Directory

Locations

1007 N Country Club Rd
Ada, OK 74820
Phone (580) 421-8700

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1303689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434585600000",
    "number": "1538450689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 N COUNTRY CLUB RD",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748202847",
            "telephone_number": "580-421-8700",
            "fax_number": "580-421-8785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 N COUNTRY CLUB RD",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748202847",
            "telephone_number": "580-421-8700",
            "fax_number": "580-421-8785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOVEREIGN FAMILY CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-25",
        "last_updated": "2015-06-18",
        "status": "A",
        "authorized_official_last_name": "ANOATUBBY",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT, SOVEREIGN",
        "authorized_official_telephone_number": "580-272-5160",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sovereign Family Practice Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ada, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.