NPIMap

Organization Active NPI

Kiamichi Family Medical Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Hugo, OK
National Provider Identifier
1902269012
Registry record updated May 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
KIAMICHI FAMILY MEDICAL CENTER, INC
Practice address
3004 E. Jackson
Hugo, OK 74743-3821
Phone
(580) 326-9555
Fax
(580) 241-5739
NPI assigned
Apr 5, 2016
Last updated
May 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2025

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

Authorized official

Name
Amy Gilbreath
Title
Ceo
Phone
(580) 241-5294

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

3004 E. Jackson
Hugo, OK 74743-3821

Mailing address

6026 Battiest Pickens Rd
Broken Bow, OK 74728-5033
Phone (580) 241-5294

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040304000870 OK Part B Supplier - Clinic/Group Practice 7315855541 Receives reassigned benefits from 15 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Broken Bow, OK; Idabel, OK
O20161012001345 OK Part A Provider - Federally Qualified Health Center (FQHC) 7315855541 Practice locations: Hugo, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902269012. Details of each certification follow.

Federally qualified health center certification: CCN 371921

Legal name
KIAMICHI FAMILY MEDICAL CENTER INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 11, 2016
Last certification
Oct 11, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 8, 2002 in OK
Enrollment address
3004 E Jackston St
Hugo, OK 74743-4037

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
37D2111588Kiamichi Family Medical Center, Inc3004 E Jackson St, Hugo, OK 74743Certificate of waiverApr 10, 2028

National Provider Directory

National Provider Directory
Tax ID family
Kiamichi Family Medical Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

3004 E Jackson St
Hugo, OK 74743
Phone (580) 326-9555

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Garrett Tipton Individual Corporate Officer Nov 15, 2017
Micheal McConnell Individual Corporate Officer May 1, 2004
Deborah Farley Individual Corporate OfficerTreasurer Sep 1, 2005
Patty Skeen Individual Corporate Officer Nov 1, 2006
Ricky Harder Individual Corporate Officer Sep 18, 2019
Scott Rickey Individual Corporate DirectorChief Financial Officer Jun 1, 2011
Kenneth Dial Individual Corporate Officer Mar 1, 2010
Stacey Ebert Individual Corporate Officer Jun 18, 2014
James Hamilton Individual Corporate Officer Oct 1, 2005
Amy Gilbreath Individual Corporate DirectorChief Executive Officer Jun 1, 2011
W-2 Managing EmployeeChief Executive Officer Jun 1, 2011
Operational/Managerial ControlChief Executive Officer Jun 1, 2011
Marla Reynolds Individual Corporate Director Nov 15, 2017

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1459814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747094400000",
    "number": "1902269012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6026 BATTIEST PICKENS RD",
            "city": "BROKEN BOW",
            "state": "OK",
            "postal_code": "747285033",
            "telephone_number": "580-241-5294",
            "fax_number": "580-241-5739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3004 E. JACKSON",
            "city": "HUGO",
            "state": "OK",
            "postal_code": "747433821",
            "telephone_number": "580-326-9555",
            "fax_number": "580-241-5739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIAMICHI FAMILY MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-05",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-05",
        "status": "A",
        "authorized_official_last_name": "GILBREATH",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "580-241-5294"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hugo, OK

Sources for this page

Verify at the official NPI Registry.