Newman Memorial Hospital, Inc
Organization Active NPI Rural Health Clinic/Center · Shattuck, OK
NPI 1821554734 · NPPES record last updated Feb 19, 2025
Key facts
- NPI
- 1821554734
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- NEWMAN MEMORIAL HOSPITAL, INC
- Practice address
- 905 S Main St
Shattuck, OK 73858-9205 - Phone
- (580) 938-5534
- NPI assigned
- Feb 15, 2019
- Organization subpart
- No
Authorized official
- Name
- Tamara Noble
- Title
- Office Manager
- Phone
- (580) 938-2551
Owners & managing parties with NPI records 1
-
Danna K Stuart, MD
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 6
Related certifications (CCN) 1
Practitioners 29
-
Shandy Baggs, ARNP
-
Amy Calhoun-Vasko, APN,CNM
-
Jeremy S Cheatwood, PA-C
-
Joanna Elliott, APRN
-
Richard D Orgill, MD
-
Bradley Dale Pittman, PA-C
-
Danna K Stuart, MD
-
Timothy Vavricka, MD
-
Isaac F. Adams, MD
-
Roy W. Bankhead, MD
-
Wendy Denae Crotts, APRN
-
Sergio G Demier, D.O.
-
Jessica Rayleen Jones, APRN-CNP
-
Bradley Lowery, M.D.
-
Mark Blaine Mann, M.D.
-
Thomas F McGarry, M.D.
-
Josh E McWilliams, M.D.
-
David T Rothwell, MD
-
Atul A Walia, D.O.
-
Zachary Daniel Zanowiak, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Rural health clinic certification: CCN 378533
- Legal name
- NEWMAN MEMORIAL HOSPITAL, INC
- Doing business as
- NEWMAN HEALTHCARE ASSOCIATES
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Apr 16, 2020
- Last certification
- Mar 21, 2023
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Dec 31, 1948 in OK
- Enrollment address
- 905 S Main St
Shattuck, OK 73858-9205 - Related CCNs
- 371336
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Delyn Pool |
Corporate Officer | Feb 28, 2022 | |
| Thomas R Vasko |
Corporate Director |
Feb 9, 2023 | |
| W-2 Managing Employee |
Feb 9, 2023 | ||
| Angela Prather |
Corporate Officer |
May 1, 2006 | |
| Gregory S Huenergardt |
Corporate Officer |
Apr 1, 2001 | |
| Danna K Stuart |
Operational/Managerial Control |
Jun 11, 2019 | |
| John Cully |
Corporate Director | Sep 30, 2016 | |
| Barclay Holt |
Corporate Officer | Feb 28, 2022 | |
| Brittany C Rash |
W-2 Managing Employee | Jun 11, 2019 | |
| Ricky Messer |
Corporate Officer | Feb 28, 2020 | |
| Jenilee Hinkle |
Corporate Director | Sep 30, 2016 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Newman Healthcare Associates Woodward |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190820002514 | OK | Part a Provider - Rural Health Clinic | 2567482367 | Practice locations: Shattuck, OK |
National Provider Directory
- Tax ID family
- Pharmacy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Critical Access Hospital Clinic/Center | 261QC0050X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
905 S Main St
Shattuck, OK 73858-9205
Mailing address
905 S Main St
Shattuck, OK 73858-9205
Phone (580) 938-2551
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100699360B | Medicaid | OK | |
| 100699360J | Medicaid | OK |
Other names
- Newman Healthcare Associates
Other providers in Shattuck, OK
- Kristen a Burris, D.D.S. L.L.C.
- Gary Willis Mitchell
- Merindy Grace Morgenson
- Newman Medical Center Pharmacy Inc
- Newman Memorial Hospital, Inc
- Newman Memorial Hospital, Inc.
- Newman Memorial Hospital, Inc.
- Newman Memorial Hospital, Inc.
- Newman Physicians' Group, Inc.
- Lisa Marie Oakley
All providers in Shattuck, 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 Feb 19, 2025. 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.