Organization
FAIRFAX MEDICAL FACILITIES, INC.
Active
Other names
Ponca City Family Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY LEEPER (CEO)
(918) 642-3100
Entity
Organization
Contact information
Practice address
122 E GRAND AVE, PONCA CITY, OK 74601-5205
(580) 203-8270
Mailing address
212 N MAIN ST, FAIRFAX, OK 74637-3023
(918) 642-3100
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200071420M
—
OK
Enumeration date
03/13/2025
Last updated
04/14/2026
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