| Family Health Center Of Southern Oklahoma Inc | |
|
610 E 24th St Tishomingo OK 73460-3245 | |
| (580) 371-2343 | |
| (580) 371-3614 |
| Full Name | Family Health Center Of Southern Oklahoma Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 610 E 24th St, Tishomingo, Oklahoma |
| Authorized Official Name and Position | Ashley Wells (CREDENTIALING OFFICER) |
| Authorized Official Contact | 5803870509 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Health Center Of Southern Oklahoma Inc 610 E 24th St Tishomingo OK 73460-3245 Ph: (580) 371-2343 | Family Health Center Of Southern Oklahoma Inc 610 E 24th St Tishomingo OK 73460-3245 Ph: (580) 371-2343 |
| NPI Number | 1598803942 |
|---|---|
| Provider Enumeration Date | 02/01/2007 |
| Last Update Date | 08/21/2024 |
| Medicare PECOS PAC ID | 4284537457 |
|---|---|
| Medicare Enrollment ID | O20040127001108 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598803942 | NPI | - | NPPES |
| 200018910C | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Oklahoma) | Primary |
| Provider Name | Paul Andrew Reel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871536862 PECOS PAC ID: 0345153276 Enrollment ID: I20031107000125 |
| Provider Name | John C Siegle |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1710073044 PECOS PAC ID: 4688587751 Enrollment ID: I20070830000646 |
| Provider Name | Glenda G Cross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649412263 PECOS PAC ID: 0941324255 Enrollment ID: I20100824000132 |
| Provider Name | Craig M Couvillon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235399403 PECOS PAC ID: 0143492017 Enrollment ID: I20111019000360 |
| Provider Name | Heather Micheal Workman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891050951 PECOS PAC ID: 3173772902 Enrollment ID: I20121011000021 |
| Provider Name | Jessica D Pickens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407257942 PECOS PAC ID: 6800118878 Enrollment ID: I20141202000205 |
| Provider Name | Tabitha Nave |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376068460 PECOS PAC ID: 0143595470 Enrollment ID: I20171012000267 |
| Provider Name | Carol Lynn Black |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013427129 PECOS PAC ID: 3971860214 Enrollment ID: I20171122000573 |
| Provider Name | Joseph Reed Hutchings |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326559683 PECOS PAC ID: 0749546521 Enrollment ID: I20181016002960 |
| Provider Name | Wilson L Davis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184633521 PECOS PAC ID: 6901717131 Enrollment ID: I20181210001042 |
| Provider Name | Relinda Lea Black |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285297598 PECOS PAC ID: 2062749757 Enrollment ID: I20190802001111 |
| Provider Name | Ashley Dawn Rogers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679842421 PECOS PAC ID: 0042644353 Enrollment ID: I20191219001304 |
| Provider Name | Tasha Renee Cummins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386279024 PECOS PAC ID: 2567892003 Enrollment ID: I20200423001672 |
| Provider Name | Brian C Musgrove |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1730447442 PECOS PAC ID: 3870914252 Enrollment ID: I20200611000770 |
| Provider Name | Ebelechukwu Ekwenugo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710535398 PECOS PAC ID: 3375979289 Enrollment ID: I20201103001128 |
| Provider Name | Linda Faye Richardson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619545795 PECOS PAC ID: 8224426762 Enrollment ID: I20211102002110 |
| Provider Name | Stephanie Patricia Jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366069841 PECOS PAC ID: 0244647709 Enrollment ID: I20220107001574 |
| Provider Name | Courtney L Huddleston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073855672 PECOS PAC ID: 5597142869 Enrollment ID: I20220509000146 |
| Provider Name | Devon Emilee Gilbert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811612443 PECOS PAC ID: 6507232006 Enrollment ID: I20221025002886 |
| Provider Name | Katrisha Nicole Toney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760188254 PECOS PAC ID: 4082088372 Enrollment ID: I20230329000271 |
| Provider Name | Joy Gibson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275036766 PECOS PAC ID: 8921456575 Enrollment ID: I20231121001498 |
| Provider Name | Melissa Sue Blackburn |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376817031 PECOS PAC ID: 7618325275 Enrollment ID: I20231121002189 |
| Provider Name | Lari L Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225300551 PECOS PAC ID: 1658729157 Enrollment ID: I20231121003879 |
| Provider Name | Amreigh Tess Daniel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225896053 PECOS PAC ID: 2860832516 Enrollment ID: I20240429003484 |
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Tishomingo Doctor's Medical Clinic, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 508 E 24th St, Tishomingo, OK 73460 Phone: 580-371-9117 Fax: 580-371-3170 | |
Family Health Center Of Southern Oklahoma Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 610 E 24th St, Tishomingo, OK 73460 Phone: 580-371-2343 Fax: 580-371-3614 | |
Chickasaw Nation Tishomingo Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 817 E 6th St, Tishomingo, OK 73460 Phone: 580-371-2392 | |
Victory Health Clinic Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 714 E Main St, Tishomingo, OK 73460 Phone: 580-371-8500 Fax: 580-371-2282 |