Family Clinic of Weleetka

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

373819 Issued in OK

Legal business name

FAMILY CLINIC OF WELEETKA

Practice address

315 W. 9TH
Weleetka, OK 74880

Phone

(405) 786-2248

Fax

(405) 786-2006

NPI assigned

Feb 1, 2008

Organization subpart

No

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

Authorized official

Name

Ms. Jan Parker, PHYSICIAN ASSISTANT

Title

Manager

Phone

(405) 786-2248

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Family Clinic of Weleetka Other name

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Rural health clinic certification: CCN 373819

Legal name

FAMILY CLINIC OF WELEETKA

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Nov 24, 1993

Last certification

Oct 13, 2023

Ownership / control type

1A

Organization structure

PartnershipProprietary

Enrollment address

315 W 9TH St
Weleetka, OK 74880-8117

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 3

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

Owners & managing parties with NPI records 2

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

• Brent Wade Davis, D.O.

  • Family Medicine Physician
  • Weleetka, OK
  • NPI 1619009859

  5% Or Greater Direct Ownership Interest

  CMS ownership
• Janet Y Parker, PA

  • Physician Assistant
  • Weleetka, OK
  • NPI 1720124472

  General Partnership Interest

  CMS ownership

Practitioners 4

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

• Janet Y Parker, PA

  • Physician Assistant
  • Weleetka, OK
  • NPI 1720124472
  NPD
• Patrick W Parker, PA-C

  • Medical Physician Assistant
  • Oklahoma City, OK
  • NPI 1952966939
  NPD
• Kimber Marie Sanderson, APRN

  • Family Nurse Practitioner
  • Weleetka, OK
  • NPI 1710519004
  NPD
• Brent Wade Davis, D.O.

  • Family Medicine Physician
  • Weleetka, OK
  • NPI 1619009859
  NPD (past)

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

{
    "created_epoch": "1201824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632787200000",
    "number": "1699953687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 337",
            "city": "WELEETKA",
            "state": "OK",
            "postal_code": "748800337",
            "telephone_number": "405-786-2248",
            "fax_number": "405-786-2006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W. 9TH",
            "city": "WELEETKA",
            "state": "OK",
            "postal_code": "74880",
            "telephone_number": "405-786-2248",
            "fax_number": "405-786-2006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CLINIC OF WELEETKA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-01",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-10",
        "status": "A",
        "authorized_official_last_name": "PARKER",
        "authorized_official_first_name": "JAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "405-786-2248",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PHYSICIAN ASSISTANT"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "OK",
            "license": "373819",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100743630B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Clinic of Weleetka",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Family Clinic of Weleetka",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Aspen Place Living Center, LLC
• Katie Nicole Burden-Greer
• Adrianne Elizabeth Collett
• Brent Wade Davis, D.O.
• Amber Lynn Doerr
• Graham Public School
• Cady Ann Marshall
• Med-Econ Drug Inc
• Candace Paige Neeley
• Janet Y Parker, PA

• Rural Health Clinic/Center in Weleetka, OK
• Providers in Weleetka, OK by specialty
• Rural Health Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.