NPIMap

Organization Active NPI

East Central Oklahoma Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Henryetta, OK
National Provider Identifier
1639636657
Registry record updated Jul 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC.
Practice address
1102 West Main Street
Henryetta, OK 74437
Phone
(918) 652-9615
Fax
(918) 652-7612
NPI assigned
Feb 26, 2019
Last updated
Jul 17, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 17, 2025

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

Authorized official

Name
Donna Dyer, MSHR
Title
Ceo
Phone
(405) 452-3151

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1102 West Main Street
Henryetta, OK 74437

Mailing address

P.O. Box 236
Wetumka, OK 74883
Phone (405) 452-3151

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090330000363 OK Part B Supplier - Clinic/Group Practice 3779643994 Receives reassigned benefits from 11 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Henryetta, OK; Wetumka, OK; Wewoka, OK
O20240109003202 OK Part A Provider - Federally Qualified Health Center (FQHC) 3779643994 Practice locations: Henryetta, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639636657. Details of each certification follow.

Federally qualified health center certification: CCN 371020

Legal name
EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 6, 2023
Last certification
Nov 6, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
in OK
Enrollment address
1102 W Main St
Henryetta, OK 74437-4232

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.

National Provider Directory

National Provider Directory
Tax ID family
East CTRL Ok Fam HLTH Ctr I3 organizations share this tax ID, including this one
Part of
East CTRL Ok Fam HLTH Ctr I

Other organizations with this tax ID 2

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

Locations

104 E Shurden Industrial Blvd
Henryetta, OK 74437
Phone (918) 652-9614

401 S Washita St
Wetumka, OK 74883
Phone (405) 452-3221

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tony Fish Individual Corporate OfficerBoard Member Chairman Jan 1, 2023
Kimberly Meeks Individual Corporate OfficerBoard Member Secretary Jan 1, 2023
Brent McGee Individual Corporate OfficerBoard Member Vice Chairman Jan 1, 2023
Vernon Stout Individual Corporate OfficerBoard Member Treasurer Jan 1, 2023
Daniel Ingle Individual Corporate DirectorBoard Member Jan 1, 2023
Michael Lindley Individual Corporate DirectorBoard Member Jan 1, 2023
Debra Kardokus Individual Corporate DirectorBoard Member Jan 1, 2023
Darin Hebert Individual Corporate DirectorBoard Member Jan 1, 2023
Gisela Williams Individual Corporate DirectorBoard Member Jan 1, 2023
Donna Dyer Individual Corporate OfficerCeo Jan 1, 2023
W-2 Managing EmployeeCeo Jan 1, 2023
Operational/Managerial ControlCeo Jan 1, 2023
Felisha Ring Individual W-2 Managing EmployeeAdministrative Assistant Human R Jan 1, 2023
Vic Woods Individual Corporate DirectorBoard Member Jan 1, 2023

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
East Central Oklahoma Family Health Center, Inc.Henryetta, OK, CCN 371886 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2012
East Central Oklahoma Family Health Center, Inc. - WewokaWewoka, OK, CCN 371911 Federally qualified health center Operational/Managerial Control Nov 16, 2015

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1551139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752710400000",
    "number": "1639636657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 236",
            "city": "WETUMKA",
            "state": "OK",
            "postal_code": "74883",
            "telephone_number": "405-452-3151",
            "fax_number": "405-452-3310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 WEST MAIN STREET",
            "city": "HENRYETTA",
            "state": "OK",
            "postal_code": "74437",
            "telephone_number": "918-652-9615",
            "fax_number": "918-652-7612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST CENTRAL OKLAHOMA FAMILY HEALTH CENTER, INC.",
        "enumeration_date": "2019-02-26",
        "last_updated": "2025-07-17",
        "certification_date": "2025-07-17",
        "status": "A",
        "authorized_official_last_name": "DYER",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "405-452-3151",
        "authorized_official_credential": "MSHR"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henryetta, OK

Sources for this page

Verify at the official NPI Registry.