NPIMap

Organization Active NPI

Holdenville Hospital Authority

Doing business as Holdenville General Hospital Physicians Health Clinic

  • Rural Health Clinic/Center
  • Holdenville, OK
National Provider Identifier
1902265309
Registry record updated Dec 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HOLDENVILLE HOSPITAL AUTHORITY
Doing business as
Holdenville General Hospital Physicians Health Clinic
Practice address
100 McDougal Dr
Holdenville, OK 74848-2822
Phone
(405) 379-4200
Fax
(405) 379-4340
NPI assigned
Feb 15, 2016
Last updated
Dec 10, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2019

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

Authorized official

Name
Mr. Stephen Stewart
Title
Ceo
Phone
(405) 379-4200

Specialties & licenses 1

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

Addresses

Primary practice location

100 McDougal Dr
Holdenville, OK 74848-2822

Mailing address

100 McDougal Dr
Holdenville, OK 74848-2822
Phone (405) 379-4200

Other names 1

  • Holdenville General Hospital Physicians Health Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140702001183 OK Part B Supplier - Clinic/Group Practice 6002031424 Receives reassigned benefits from 15 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wewoka, OK; Holdenville, OK
O20160725001107 OK Part A Provider - Rural Health Clinic 6002031424 Practice locations: Holdenville, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902265309. Details of each certification follow.

Rural health clinic certification: CCN 373488

Legal name
HOLDENVILLE HOSPITAL AUTHORITY
Doing business as
HOLDENVILLE GENERAL HOSPITAL PHYSICIAN HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 13, 2016
Last certification
Oct 9, 2025
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
100 McDougal Drive
Holdenville, OK 74848-2822
Related CCNs
371321

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Locations

1401 W 1st St
Wewoka, OK 74884
Phone (405) 257-3396

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
James a Peterson Individual Contracted Managing EmployeeCfo Apr 6, 2022
Corporate OfficerCfo Sep 1, 2021
Stephen C Stewart Individual Contracted Managing EmployeeCeo Oct 16, 2018
Corporate OfficerCeo Oct 16, 2018
Shirley D Orr Individual Corporate OfficerCno Jun 1, 2018
W-2 Managing EmployeeCno Oct 16, 2018
Holdenville Hospital Authority Organization, Holdenville, OK 5% Or Greater Direct Ownership Interest May 1, 2016 100%
Chrystal D Landers Individual W-2 Managing EmployeeBusiness Office Manager May 1, 2016 100%

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Holdenville General HospitalHoldenville, OK, CCN 37Z321 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 17, 1998
Holdenville General HospitalHoldenville, OK, CCN 371321 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 17, 1998
Holdenville General Hospital Rural Health ClinicHoldenville, OK, CCN 373994 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 17, 1998
Holdenville General Hospital Wewoka Health ClinicWewoka, OK, CCN 373477 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2015

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1455494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575936000000",
    "number": "1902265309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MCDOUGAL DR",
            "city": "HOLDENVILLE",
            "state": "OK",
            "postal_code": "748482822",
            "telephone_number": "405-379-4200",
            "fax_number": "405-379-4340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MCDOUGAL DR",
            "city": "HOLDENVILLE",
            "state": "OK",
            "postal_code": "748482822",
            "telephone_number": "405-379-4200",
            "fax_number": "405-379-4340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLDENVILLE HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-15",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "405-379-4200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Holdenville General Hospital Physicians Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Holdenville General Hospital Physicians Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Holdenville, OK

Sources for this page

Verify at the official NPI Registry.