NPIMap

Organization Active NPI

Leflore County Hospital Authority

  • Family Medicine Physician
  • Poteau, OK
National Provider Identifier
1578026571
Registry record updated May 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LEFLORE COUNTY HOSPITAL AUTHORITY
Practice address
104 S East Blvd
Poteau, OK 74953
Phone
(918) 635-3576
Fax
(918) 635-3158
NPI assigned
Apr 8, 2019
Organization subpart
Yes
Parent organization
LEFLORE COUNTY HOSPITAL AUTHORITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 14, 2025

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Rural Health Clinic/Center 261QR1300X

Addresses

Primary practice location

104 S East Blvd
Poteau, OK 74953

Mailing address

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

Other practice location 1

1013 Dewey Ave
Poteau, OK 74953-4409
Phone (918) 647-2929

Other identifiers 1

IdentifierTypeStateIssuer
513012MedicaidOK

Other names 1

  • Cavanal Medical Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL 12/31/2040 Health Information Exchange (HIE)

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
O20200113000839 OK Part A Provider - Rural Health Clinic 7719916956 Practice locations: Poteau, OK

Rural health clinic certification: CCN 378536

Legal name
LEFLORE COUNTY HOSPITAL AUTHORITY
Doing business as
CAVANAL MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 26, 2020
Last certification
May 20, 2023
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
104 South East Blvd
Poteau, OK 74953-0001
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
37D1002120Cavanal Medical Clinic104 South East Blvd, Poteau, OK 74953Certificate of waiverJun 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Eastern Okla Med Center4 organizations share this tax ID, including this one
Part of
Eastern Okla Med Center

Other organizations with this tax ID 3

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

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
Logan Hayes Individual Corporate OfficerCoo May 23, 2023
Leflore County Hospital Authority Organization, Poteau, OK Non-profit 5% Or Greater Indirect Ownership Interest Apr 1, 2019 100%
Tiffany B Griffis Individual Operational/Managerial ControlCeo Jan 1, 2025 100%
Audrey Balentine Individual Corporate OfficerMember Jan 1, 2022

Owners & managing parties with NPI records 4

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
Heavener Medical ClinicHeavener, OK, CCN 373480 Rural health clinic Operational/Managerial Control Jan 1, 2014

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1554681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747180800000",
    "number": "1578026571",
    "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": "104 S EAST BLVD",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "74953",
            "telephone_number": "918-635-3576",
            "fax_number": "918-635-3158"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1013 Dewey Ave",
            "address_purpose": "LOCATION",
            "city": "Poteau",
            "state": "OK",
            "postal_code": "749534409",
            "country_code": "US",
            "telephone_number": "918-647-2929",
            "fax_number": "918-647-2288",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LEFLORE COUNTY HOSPITAL AUTHORITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEFLORE COUNTY HOSPITAL AUTHORITY",
        "enumeration_date": "2019-04-08",
        "last_updated": "2025-05-14",
        "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": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "513012",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "12/31/2040",
            "affiliation": "N",
            "endpointDescription": "Eastern Oklahoma Medical Center",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Poteau",
            "address_1": "1013 Dewey Ave",
            "city": "Poteau",
            "state": "OK",
            "country_code": "US",
            "postal_code": "749534409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Cavanal Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cavanal Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poteau, OK

Sources for this page

Verify at the official NPI Registry.