Organization
KIAMICHI FAMILY MEDICAL CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY GILBREATH (CEO)
(580) 241-5294
Entity
Organization
Contact information
Practice address
6026 BATTIEST PICKENS RD, BROKEN BOW, OK 74728-5033
(580) 241-5294
(580) 241-5739
Mailing address
PO BOX 180, BATTIEST, OK 74722-0180
(580) 241-5294
(580) 241-5739
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200003420A
—
OK
Enumeration date
08/05/2006
Last updated
09/03/2015
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