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Arbuckle Memorial Hospital

Organization Active NPI Rural Health Clinic/Center · Davis, OK

NPI 1821972076 · NPPES record last updated Sep 12, 2025

Key facts

NPI
1821972076
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
ARBUCKLE MEMORIAL HOSPITAL
Practice address
109-C W. Main St
Davis, OK 73030-1764
Phone
(580) 622-8205
Fax
(580) 203-3515
NPI assigned
Aug 1, 2025
Organization subpart
Yes
Parent organization (as reported)
ARBUCKLE MEMORIAL HOSPITAL

Authorized official

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

Other NPIs on the same Medicare enrollment 2

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

Other NPIs with the same Medicare PAC ID 2

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

Corporate family (same tax ID) 4

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

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

Facilities with the same owner 35

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

View all 35

Practitioners 24

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

Laboratory certificates & supplier records

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

CLIA laboratory certificates

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in OK

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
Government · Non-profit
Enrollment address
109 W Main St
Ste C
Davis, OK 73030-1764
Related CCNs
371328

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 Employee
Ceo		 Dec 1, 2017
Corporate Officer
Ceo		 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 Officer
Cfo		 Jul 9, 2001
W-2 Managing Employee
Cfo		 Jul 9, 2001

Medicare enrollment records

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

National Provider Directory

Tax ID family
Arbuckle Family Clinic (5 organizations share this tax ID)
Part of
Arbuckle Family Clinic

Locations

2007 W Broadway Ave
Sulphur, OK 73086
Phone (580) 622-3511

Specialties & licenses

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

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

  • Arbuckle Family Clinic at Davis Doing business as

Other providers in Davis, OK

All providers in Davis, OK · Rural Health Clinic/Center in Oklahoma

Sources for this page

Verify at the official NPI Registry.