Central Oklahoma Family Medical Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Konawa, OK
NPI 1831291293 · NPPES record last updated Jan 31, 2022
Key facts
- NPI
- 1831291293
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- CENTRAL OKLAHOMA FAMILY MEDICAL CENTER, INC.
- Practice address
- 527 West 3Rd St
Konawa, OK 74849 - Phone
- (580) 925-3286
- Fax
- (580) 925-2362
- NPI assigned
- Sep 5, 2006
- Organization subpart
- No
Authorized official
- Name
- Brenda Ware
- Title
- Ceo
- Phone
- (580) 925-3286
Owned or controlled facilities with NPI records 10
Other NPIs on the same Medicare enrollment 15
Other NPIs with the same Medicare PAC ID 14
Practitioners 71
-
Melissa Lynn Adams, D.P.M
-
Jody Wayne Ardrey, ARNP-CNP
-
Lynn Dean Baggett, M.D.
-
Gayla Beth Branscum, LMHP
-
Justin Burnett, MD
-
Penni Cartlidge, APRN-CNP
-
Charlysa Diana Gatlin Castillo, APRN CNP
-
Semira Charboneau, D.O.
-
Lindsey Sue Conner, APRN
-
Michel Danette Cosby, APRN
-
Amanda Lynn Cubit, NP-C
-
Emily Nicole Davis, APRN-CNP
-
Laura Lindsey Dooley, ARNP
-
John Keith Falsarella, M.D.
-
Jenna Geohagan, M.D.
-
Curtis E Harris, MD
-
Amber Holbein, MD
-
Brooke Nicole Houck, APRN-CNM, WHNP- BC
-
Annika Marie Jennings, APRN-CNP
-
Randall Leon Kemp, D.O.
-
Meagan Joyce Kite, CNM
-
Amanda Lauren Kuehner, APRN-CNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
All facility ownership & control disclosures 10
| Facility | Type | Role | Since |
|---|---|---|---|
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Jul 1, 1986 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 1, 2019 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Mar 25, 2002 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control | Sep 1, 2021 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control | Sep 1, 2021 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control | Jan 11, 2022 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control | May 3, 2022 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control | Jun 1, 2022 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control | Feb 1, 2022 |
| Central Oklahoma Family Medical Center Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Mar 25, 2002 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040722001013 | OK | Part B Supplier - Clinic/Group Practice | 9931189685 |
Receives reassigned benefits from 68 practitioners 15 other NPIs on this enrollment Practice locations: Seminole, OK; Stratford,, OK; Konawa, OK; Ada, OK |
National Provider Directory
Locations
905 Colony Dr
#A
Ada, OK 74820
930 N Country Club Rd
Ada, OK 74820
2249 Boren Blvd
Ste A
Seminole, OK 74868
302 W Smith
Stratford, OK 74872
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
527 West 3Rd St
Konawa, OK 74849
Mailing address
527 West 3Rd Street
Konawa, OK 74849
Phone (580) 925-3286
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100737160D | Medicaid | OK |
Other names
- Central Oklahoma Family Med Center
Other providers in Konawa, OK
- Central Oklahoma Family Medical Center
- Central Oklahoma Family Medical Center Inc
- Central Oklahoma Family Medical Center Pharmacy
- Central Oklahoma Family Medical Center, Inc
- Central Oklahoma Family Medical Center, Inc.
- Doris Chance
- William H Chesser
- City of Konawa
- Lindsey Clark
- Kolby Len Cox
All providers in Konawa, OK · Federally Qualified Health Center (FQHC) in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2022. 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.