Shortgrass Community Health Center, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Altus, OK
NPI 1982263752 · NPPES record last updated Dec 14, 2023
Key facts
- NPI
- 1982263752
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- SHORTGRASS COMMUNITY HEALTH CENTER, INC
- Practice address
- 101 S Hudson St
Altus, OK 73521-4215 - Phone
- (580) 688-2800
- Fax
- (580) 688-2193
- NPI assigned
- Jun 6, 2019
- Organization subpart
- Yes
- Parent organization (as reported)
- SHORTGRASS COMMUNITY HEALTH CENTER
Authorized official
- Name
- Janet Lynn Tipton
- Title
- Office Manager
- Phone
- (680) 688-2800
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 3
Practitioners 17
-
Brian J Bauer, MSN
-
Kimberly Ranee Cline, APRN-CNP
-
Kimberly Yvette Hestand, NP-C
-
Kristi Nicole Fry, APRN
-
Jennifer Sharp Kauffman, LCSW
-
Briana King, MSW, LCSW
-
William J Kok, MD
-
Manda Lea Stephens, APRN, CNP
-
Shawna D Ward, MA
-
Erica E De Santos, A.P.R.N
-
Madison Rhodes, OD
-
Jada Alexandra Bost, LPC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 37D2051994 | Shortgrass Community Health Center, Inc | Certificate of waiver | Jan 2, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20121101000597 | OK | Part B Supplier - Clinic/Group Practice | 9234385535 |
Receives reassigned benefits from 12 practitioners 1 other NPI on this enrollment Practice locations: Altus, OK; Hollis, OK |
National Provider Directory
- Tax ID family
- Shortgrass Community Health Center Inc
- Part of
- Shortgrass Community Health Center Inc
Locations
211 E Broadway St
Altus, OK 73521
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
101 S Hudson St
Altus, OK 73521-4215
Mailing address
400 East Sycamore Street
Hollis, OK 73550
Phone (680) 688-2800
Other providers in Altus, OK
- Jon Shelton
- Lisa Michelle Shelton
- Carol Marie Sherman
- Stanley Robert Sherman
- Kirstie Lea Shive
- Tom H Shurley
- Julianne Rodgers Shytle
- San Juanita Silva
- Ken Simmons
- Samantha Marie Sims
All providers in Altus, 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 Dec 14, 2023. 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.
- 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.