NPIMap

Organization Active NPI

Grady Memorial Hospital

Doing business as FOMG Clinical Medical Laboratory

  • Clinical Medical Laboratory
  • Chickasha, OK
National Provider Identifier
1669558789
Registry record updated Jan 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
GRADY MEMORIAL HOSPITAL
Doing business as
FOMG Clinical Medical Laboratory
Practice address
2100 W Iowa Ave
Chickasha, OK 73018-2736
Phone
(405) 224-2100
Fax
(405) 779-2346
NPI assigned
Oct 31, 2006
Last updated
Jan 6, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2026

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

Authorized official

Name
Steve Pautler
Title
Ceo
Phone
(405) 779-2150

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

2100 W Iowa Ave
Chickasha, OK 73018-2736

Mailing address

2100 W Iowa Ave
Chickasha, OK 73018-2736
Phone (405) 224-2100

Other identifiers 1

IdentifierTypeStateIssuer
100700820HMedicaidOK

Other names 1

  • FOMG Clinical Medical Laboratory 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
37D0958119Grady Memorial Hospital2100 Iowa, Chickasha, OK 73018AccreditationFeb 28, 2028

National Provider Directory

National Provider Directory
Tax ID family
Grady Mem Dba 5 Oaks Me6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767657600000",
    "number": "1669558789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 W IOWA AVE",
            "city": "CHICKASHA",
            "state": "OK",
            "postal_code": "730182736",
            "telephone_number": "405-224-2100",
            "fax_number": "405-779-2346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 W IOWA AVE",
            "city": "CHICKASHA",
            "state": "OK",
            "postal_code": "730182736",
            "telephone_number": "405-224-2100",
            "fax_number": "405-779-2346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRADY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2026-01-06",
        "certification_date": "2026-01-06",
        "status": "A",
        "authorized_official_last_name": "PAUTLER",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "405-779-2150"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100700820H",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FOMG Clinical Medical Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chickasha, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2026; 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.