| Shortgrass Community Health Center, Inc | |
|
101 S Hudson St Altus OK 73521-4215 | |
| (580) 688-2800 | |
| (580) 688-2193 |
| Full Name | Shortgrass Community Health Center, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 101 S Hudson St, Altus, Oklahoma |
| Authorized Official Name and Position | Janet Lynn Tipton (OFFICE MANAGER) |
| Authorized Official Contact | 6806882800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shortgrass Community Health Center, Inc 400 East Sycamore Street Hollis OK 73550 Ph: (680) 688-2800 | Shortgrass Community Health Center, Inc 101 S Hudson St Altus OK 73521-4215 Ph: (580) 688-2800 |
| NPI Number | 1982263752 |
|---|---|
| Provider Enumeration Date | 06/06/2019 |
| Last Update Date | 12/14/2023 |
| Medicare PECOS PAC ID | 9234385535 |
|---|---|
| Medicare Enrollment ID | O20121101000597 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982263752 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | James L Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477566180 PECOS PAC ID: 4082519301 Enrollment ID: I20031201000351 |
| Provider Name | William J Kok |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033252804 PECOS PAC ID: 8325003932 Enrollment ID: I20080822000142 |
| Provider Name | Manda Lea Stephens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831471101 PECOS PAC ID: 3274706726 Enrollment ID: I20111227000311 |
| Provider Name | Kimberly Y Hestand |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114391315 PECOS PAC ID: 4082917190 Enrollment ID: I20160125000661 |
| Provider Name | Kimberly R Cline |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538811534 PECOS PAC ID: 8921493420 Enrollment ID: I20220321000361 |
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