NPIMap

Organization Active NPI

Arbuckle Memorial Hospital

Doing business as Arbuckle Family Clinic at Davis

  • Rural Health Clinic/Center
  • Davis, OK
National Provider Identifier
1821972076
Registry record updated Sep 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ARBUCKLE MEMORIAL HOSPITAL
Doing business as
Arbuckle Family Clinic at Davis
Practice address
109-C W. Main St
Davis, OK 73030-1764
Phone
(580) 622-8205
Fax
(580) 203-3515
NPI assigned
Aug 1, 2025
Last updated
Sep 12, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
ARBUCKLE MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 12, 2025

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

Authorized official

Name
Jeremy Jones
Title
Ceo
Phone
(580) 622-8200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

109-C W. Main St
Davis, OK 73030-1764

Mailing address

PO Box 1109
Sulphur, OK 73086-8109
Phone (580) 622-8205

Other names 1

  • Arbuckle Family Clinic at Davis Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031113000508 OK Part B Supplier - Clinic/Group Practice 0840104956 Receives reassigned benefits from 20 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Davis, OK; Sulphur, OK
O20251020001032 OK Part A Provider - Rural Health Clinic 0840104956 Practice locations: Davis, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821972076. Details of each certification follow.

Rural health clinic certification: CCN 378565

Legal name
ARBUCKLE MEMORIAL HOSPITAL
Doing business as
ARBUCKLE FAMILY CLINIC AT DAVIS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 10, 2026
Last certification
Mar 10, 2026
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
109 W Main St
Ste C
Davis, OK 73030-1764
Related CCNs
371328

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
37D2329068Arbuckle Family Clinic at Davis109-C W Main St, Davis, OK 73030Certificate of waiverAug 20, 2027

National Provider Directory

National Provider Directory
Tax ID family
Arbuckle Family Clinic5 organizations share this tax ID, including this one
Part of
Arbuckle Family Clinic

Other organizations with this tax ID 4

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

Locations

109 W Main St
Ste C
Davis, OK 73030
Phone (580) 369-3600

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Jeremy Jones Individual Contracted Managing EmployeeCeo Dec 1, 2017
Corporate OfficerCeo Dec 1, 2017
Preferred Management Corporation Organization, Shawnee, OK Management services company Operational/Managerial Control Jan 1, 1996
Murray County Organization, Sulphur, OK 5% Or Greater Direct Ownership Interest Jan 1, 1966 100%
Denise L Welch Individual Corporate OfficerCfo Jul 9, 2001
W-2 Managing EmployeeCfo Jul 9, 2001

Facilities with the same owner 35

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 35

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1754006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757635200000",
    "number": "1821972076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1109",
            "city": "SULPHUR",
            "state": "OK",
            "postal_code": "730868109",
            "telephone_number": "580-622-8205",
            "fax_number": "580-203-3515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109-C W. MAIN ST",
            "city": "DAVIS",
            "state": "OK",
            "postal_code": "730301764",
            "telephone_number": "580-622-8205",
            "fax_number": "580-203-3515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARBUCKLE MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ARBUCKLE MEMORIAL HOSPITAL",
        "enumeration_date": "2025-08-01",
        "last_updated": "2025-09-12",
        "certification_date": "2025-09-12",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "580-622-8200"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arbuckle Family Clinic at Davis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Davis, OK

Sources for this page

Verify at the official NPI Registry.