Cah Acquisition Company 12 LLC
Organization Active NPI Rural Health Clinic/Center · Pawnee, OK
NPI 1598039620 · NPPES record last updated Jul 16, 2018
Key facts
- NPI
- 1598039620
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 2274 (OK)
- Legal business name
- CAH ACQUISITION COMPANY 12 LLC
- Practice address
- 535 6TH St
Pawnee, OK 74058 - Phone
- (918) 762-3942
- Fax
- (918) 762-4675
- NPI assigned
- Mar 7, 2012
- Organization subpart
- Yes
- Parent organization (as reported)
- CAH ACQUISITION COMPANY 12 LLC
Authorized official
- Name
- Tina J Steele
- Title
- Ceo
- Phone
- (918) 642-3291
Parent organization (reported in NPPES) 1
Change of ownership 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Mar 20, 2020 | Change of Ownership |
Rural Wellness Pawnee Clinic |
National Provider Directory
- Part of
- Cah Acquisition Company 12 LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 2274 | OK | Yes |
Addresses
Primary practice location
535 6TH St
Pawnee, OK 74058
Mailing address
40 Hospital Rd
Fairfax, OK 74637-5084
Phone (918) 642-3291
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200311270E | Medicaid | OK |
Other names
- THE PAWNEE CLINIC
Other providers in Pawnee, OK
- Gabrielle Sue Bottger
- Krista L Bright
- Kellie R Bryant
- Kristi Marie Bryant
- James Robert Burnham IX
- Laci Jolee Campbell
- CHI Inc
- Kelli Christensen
- City of Pawnee
- Mee-Kai Clark
All providers in Pawnee, OK · Rural Health Clinic/Center in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.