NPIMap

Organization Active NPI

Leflore County Hospital Authority

Doing business as Heavener Medical Clinic

  • Rural Health Clinic/Center
  • Heavener, OK
National Provider Identifier
1558740837
Registry record updated May 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
373480 Issued in OK
Legal business name
LEFLORE COUNTY HOSPITAL AUTHORITY
Doing business as
Heavener Medical Clinic
Practice address
304 Highway 59 N
Heavener, OK 74937-2255
Phone
(918) 653-2918
Fax
(918) 653-3211
NPI assigned
May 20, 2015
Last updated
May 8, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
LEFLORE COUNTY HOSPITAL AUTHORITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 8, 2025

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

Authorized official

Name
Tiffany B GriffisNPI 1699215228
Title
Ceo
Phone
(918) 635-3441

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 373480 OK Primary

Addresses

Primary practice location

304 Highway 59 N
Heavener, OK 74937-2255

Mailing address

105 Wall St
Poteau, OK 74953-4433
Phone (918) 635-3566

Other identifiers 1

IdentifierTypeStateIssuer
100700730IMedicaidOK

Other names 1

  • Heavener Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060804000192 OK Part B Supplier - Clinic/Group Practice 7719916956 Receives reassigned benefits from 26 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Heavener, OK; Poteau, OK
O20140708001250 OK Part A Provider - Rural Health Clinic 7719916956 1 other NPI on this enrollment
Practice locations: Heavener, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1558740837. Details of each certification follow.

Rural health clinic certification: CCN 373480

Legal name
LEFLORE COUNTY HOSPITAL AUTHORITY
Doing business as
HEAVENER MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 12, 2015
Last certification
Dec 11, 2023
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
Mar 3, 2005 in OK
Enrollment address
304 Highway 59 N
Heavener, OK 74937-2255
Related CCNs
371337

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

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
37D0702943Heavener Medical Clinic304 Highway 59 North, Heavener, OK 74937Certificate of waiverJan 12, 2028

National Provider Directory

National Provider Directory
Tax ID family
Leflore County Hospital Authority4 organizations share this tax ID, including this one
Part of
Leflore County Hospital Authority

Other organizations with this tax ID 3

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

Locations

203 Dallas St
Talihina, OK 74571
Phone (915) 567-2116

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
Cassie Lee Hempen Individual W-2 Managing Employee Apr 10, 2018
Carl Robert Reed Individual Corporate OfficerMember May 1, 2014
Logan Hayes Individual Corporate OfficerCeo/Coo May 23, 2023
Darla Ford Individual Corporate OfficerCno Jun 1, 2020
Leflore County Hospital Authority Organization, Poteau, OK Operational/Managerial Control Jan 1, 2014
Joe Mode Individual Corporate OfficerMember Jan 1, 2022
Jerry Andrews Individual Corporate OfficerBoard Chairman Jan 1, 2022

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Eastern Oklahoma Medical CenterPoteau, OK, CCN 37Z337 Hospital Operational/Managerial Control Apr 1, 2015
Eastern Oklahoma Medical CenterPoteau, OK, CCN 371337 Hospital Operational/Managerial Control Apr 1, 2015
Family Medical ClinicPoteau, OK, CCN 373479 Rural health clinic Operational/Managerial Control Jan 1, 2014
Cavanal Medical ClinicPoteau, OK, CCN 378536 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Apr 1, 2019

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1432080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746662400000",
    "number": "1558740837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 WALL ST",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749534433",
            "telephone_number": "918-635-3566",
            "fax_number": "918-635-3568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 HIGHWAY 59 N",
            "city": "HEAVENER",
            "state": "OK",
            "postal_code": "749372255",
            "telephone_number": "918-653-2918",
            "fax_number": "918-653-3211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEFLORE COUNTY HOSPITAL AUTHORITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEFLORE COUNTY HOSPITAL AUTHORITY",
        "enumeration_date": "2015-05-20",
        "last_updated": "2025-05-08",
        "certification_date": "2025-05-08",
        "status": "A",
        "authorized_official_last_name": "GRIFFIS",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-635-3441"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "OK",
            "license": "373480",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100700730I",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heavener Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Heavener Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Heavener, OK

Sources for this page

Verify at the official NPI Registry.