NPIMap

Organization Active NPI

Ahs Henryetta Hospital LLC

Doing business as Utica Park Clinic Family Care

  • Rural Health Clinic/Center
  • Henryetta, OK
National Provider Identifier
1871008722
Registry record updated Jun 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
AHS HENRYETTA HOSPITAL LLC
Doing business as
Utica Park Clinic Family Care
Practice address
2403 W Main St
Henryetta, OK 74437
Phone
(918) 652-6950
Fax
(918) 652-7827
NPI assigned
Dec 13, 2017
Last updated
Jun 4, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
AHS HILLCREST HEALTHCARE SYSTEM, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 4, 2019

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

Authorized official

Name
Stephen C. Petrovich
Title
Evp
Phone
(615) 296-3000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

2403 W Main St
Henryetta, OK 74437

Mailing address

2401 W Main St
Henryetta, OK 74437-3893
Phone (918) 652-6950

Other names 1

  • Utica Park Clinic Family Care Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050219000008 OK Part B Supplier - Clinic/Group Practice 9638143282 Receives reassigned benefits from 12 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Henryetta, OK
O20190702002822 OK Part A Provider - Rural Health Clinic 9638143282 Practice locations: Henryetta, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871008722. Details of each certification follow.

Rural health clinic certification: CCN 378527

Legal name
AHS HENRYETTA HOSPITAL LLC
Doing business as
UTICA PARK CLINIC FAMILY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 23, 2019
Last certification
Feb 13, 2025
Ownership / control type
1B
Organization structure
LLCProprietary
Enrollment address
2403 W Main St
Henryetta, OK 74437-3893
Related CCNs
370183

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

Other NPIs with the same Medicare PAC ID 3

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
37D0892289Utica Park Clinic Family Care2403 West Main Street, Henryetta, OK 74437Certificate of waiverSep 26, 2026

National Provider Directory

National Provider Directory
Tax ID family
Ahs Henryetta Hospital LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

124 W Main St
Henryetta, OK 74437
Phone (918) 652-2307

1924 W Main St
Henryetta, OK 74437
Phone (918) 652-9650

2403 W Main St
Henryetta, OK 74437
Phone (918) 652-6950

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Ardent Health Inc Organization, Brentwood, TN LLC 5% Or Greater Indirect Ownership Interest Aug 4, 2015 100%
Kevin Gross Individual Corporate OfficerPresident Aug 4, 2015
W-2 Managing Employee Sep 1, 2021 100%
Ahs Oklahoma, LLC Organization, Brentwood, TN LLC 5% Or Greater Indirect Ownership Interest Jan 1, 2019 100%
Martin Bonick Individual Corporate OfficerCeo-Chain Home Office Aug 19, 2020
Ahs Hillcrest Healthcare System LLC Organization, Brentwood, TN LLC 5% Or Greater Direct Ownership Interest Aug 4, 2015 100%
Mary a Crabtree Individual Corporate OfficerVP and Treasurer Aug 4, 2015
Ahs Management Company Inc. Organization, Brentwood, TN Corporation Operational/Managerial Control Aug 4, 2015 100%
Stephen C Petrovich Individual Corporate OfficerEvp and Secretary Aug 4, 2015
Ardent Legacy Holdings LLC Organization, Brentwood, TN LLC 5% Or Greater Indirect Ownership Interest Aug 4, 2015 100%
Ahp Health Partners, Inc Organization, Brentwood, TN Corporation 5% Or Greater Indirect Ownership Interest Jan 1, 2019 100%

Facilities with the same owner 61

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

  • Ahs Claremore Regional Hospital LLC
    • Rural Health Clinic/Center
    • Claremore, OK
    • NPI 1356974687

    Ahp Health Partners, Inc, Ahs Hillcrest Healthcare System LLC, Ahs Management Company Inc., Ahs Oklahoma, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC

    CMS ownership
  • Ahs Claremore Regional Hospital, LLC
    • Rural Health Clinic/Center
    • Claremore, OK
    • NPI 1316579642

    Ahp Health Partners, Inc, Ahs Hillcrest Healthcare System LLC, Ahs Management Company Inc., Ahs Oklahoma, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC

    CMS ownership
  • Ahs Claremore Regional Hospital, LLC.

    dba Hillcrest Hospital Claremore

    • General Acute Care Hospital
    • Claremore, OK
    • NPI 1023398807

    Ahp Health Partners, Inc, Ahs Hillcrest Healthcare System LLC, Ahs Management Company Inc., Ahs Oklahoma, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC

    CMS ownership
  • Ahs Cushing Hospital LLC

    dba Hillcrest Hospital Cushing

    • Medicare Defined Swing Bed Hospital Unit
    • Cushing, OK
    • NPI 1467523894

    Ahp Health Partners, Inc, Ahs Hillcrest Healthcare System LLC, Ahs Management Company Inc., Ahs Oklahoma, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC

    CMS ownership
  • Ahs Cushing Hospital LLC

    dba Cushing Regional Hospital

    • General Acute Care Hospital
    • Cushing, OK
    • NPI 1801867643

    Ahp Health Partners, Inc, Ahs Hillcrest Healthcare System LLC, Ahs Management Company Inc., Ahs Oklahoma, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC

    CMS ownership
  • Ahs Henryetta Hospital LLC

    dba Utica Park Clinic Primary Care

    • Rural Health Clinic/Center
    • Henryetta, OK
    • NPI 1295232478

    Ahp Health Partners, Inc, Ahs Hillcrest Healthcare System LLC, Ahs Oklahoma, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC

    CMS ownership
  • Ahs Henryetta Hospital LLC
    • Medicare Defined Swing Bed Hospital Unit
    • Henryetta, OK
    • NPI 1588733828

    Ahp Health Partners, Inc, Ahs Hillcrest Healthcare System LLC, Ahs Management Company Inc., Ahs Oklahoma, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC

    CMS ownership
  • Ahs Henryetta Hospital LLC

    dba Hillcrest Hospital Henryetta

    • General Acute Care Hospital
    • Henryetta, OK
    • NPI 1720053556

    Ahp Health Partners, Inc, Ahs Hillcrest Healthcare System LLC, Ahs Management Company Inc., Ahs Oklahoma, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC

    CMS ownership
  • Ahs Hillcrest Medical Center LLC

    dba Hillcrest Medical Center

    • Rehabilitation Hospital Unit
    • Tulsa, OK
    • NPI 1679652192

    Ahp Health Partners, Inc, Ahs Hillcrest Healthcare System LLC, Ahs Management Company Inc., Ahs Oklahoma, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC

    CMS ownership
  • Ahs Hillcrest Medical Center, LLC

    dba Hillcrest Medical Center

    • General Acute Care Hospital
    • Tulsa, OK
    • NPI 1629057229

    Ahp Health Partners, Inc, Ahs Hillcrest Healthcare System LLC, Ahs Management Company Inc., Ahs Oklahoma, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC

    CMS ownership
  • Ahs Oklahoma Physician Group, LLC

    dba Cushing Medical Specialist

    • Rural Health Clinic/Center
    • Cushing, OK
    • NPI 1922683051

    Ahp Health Partners, Inc, Ahs Hillcrest Healthcare System LLC, Ahs Management Company Inc., Ahs Oklahoma, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC

    CMS ownership
  • Ahs Pryor Hospital, LLC

    dba Utica Park Clinic Elliott

    • Rural Health Clinic/Center
    • Pryor, OK
    • NPI 1134632037

    Ahp Health Partners, Inc, Ahs Hillcrest Healthcare System LLC, Ahs Management Company Inc., Ahs Oklahoma, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC

    CMS ownership
View all 61

Practitioners & affiliated clinicians

Practitioners 50

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 50

NPI Registry JSON

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

{
    "created_epoch": "1513123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559606400000",
    "number": "1871008722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 W MAIN ST",
            "city": "HENRYETTA",
            "state": "OK",
            "postal_code": "744373893",
            "telephone_number": "918-652-6950",
            "fax_number": "918-652-7827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2403 W MAIN ST",
            "city": "HENRYETTA",
            "state": "OK",
            "postal_code": "74437",
            "telephone_number": "918-652-6950",
            "fax_number": "918-652-7827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AHS HENRYETTA HOSPITAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AHS HILLCREST HEALTHCARE SYSTEM, LLC",
        "enumeration_date": "2017-12-13",
        "last_updated": "2019-06-04",
        "status": "A",
        "authorized_official_last_name": "PETROVICH",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "EVP",
        "authorized_official_telephone_number": "615-296-3000"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Utica Park Clinic Family Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henryetta, OK

Sources for this page

Verify at the official NPI Registry.