Kiamichi Family Medical Center, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Hugo, OK
NPI 1902269012 · NPPES record last updated May 13, 2025
Key facts
- NPI
- 1902269012
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 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
- Organization subpart
- No
Authorized official
- Name
- Amy Gilbreath
- Title
- Ceo
- Phone
- (580) 241-5294
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 1
Practitioners 14
-
Lisa A Baracker, DO
-
Tonya Joy Boles, PAC
-
Bambi A Clay, PA-C
-
Tammy Michelle Williams, PA-C
-
John D Lindsey, M.D.
-
Beth Lee Leader, DO
-
Jamie Bivings, LCSW
-
Tabatha Leforce, APRN
-
Natorrie D'Atra Morris, APRN
-
David Jordan Paslay, M.D.
-
Mark Wade Ziegler, DMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 37D2111588 | Kiamichi Family Medical Center, Inc | Certificate of waiver | Apr 10, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OK
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
- Corporation · Non-profit
- Incorporated
- Jan 8, 2002 in OK
- Enrollment address
- 3004 E Jackston St
Hugo, OK 74743-4037
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Garrett Tipton |
Corporate Officer | Nov 15, 2017 | |
| Micheal McConnell |
Corporate Officer | May 1, 2004 | |
| Deborah Farley |
Corporate Officer |
Sep 1, 2005 | |
| Patty Skeen |
Corporate Officer | Nov 1, 2006 | |
| Ricky Harder |
Corporate Officer | Sep 18, 2019 | |
| Scott Rickey |
Corporate Director |
Jun 1, 2011 | |
| Kenneth Dial |
Corporate Officer | Mar 1, 2010 | |
| Stacey Ebert |
Corporate Officer | Jun 18, 2014 | |
| James Hamilton |
Corporate Officer | Oct 1, 2005 | |
| Amy Gilbreath |
Corporate Director |
Jun 1, 2011 | |
| W-2 Managing Employee |
Jun 1, 2011 | ||
| Operational/Managerial Control |
Jun 1, 2011 | ||
| Marla Reynolds |
Corporate Director | Nov 15, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Kiamichi Family Medical Center
Locations
3004 E Jackson St
Hugo, OK 74743
Phone (580) 326-9555
2809 NE Lincoln Rd
Idabel, OK 74745
Phone (580) 286-6688
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
Other providers in Hugo, OK
- Suzanne Renee Jordan
- Freddy J Kemp
- Jori Ketchum
- Lucas Christian Keyes
- Kiamichi Council on Alcoholism and Or Other Drug Abuse, Inc.
- Kiamichi Opportunities
- Kiamichi Opportunities
- Kiamichi Opportunities
- Kiamichi Opportunities
- Kiamichi Opportunities
All providers in Hugo, 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 May 13, 2025. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.