Healthcare Provider Details

I. General information

NPI: 1982263752
Provider Name (Legal Business Name): SHORTGRASS COMMUNITY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S HUDSON ST
ALTUS OK
73521-4215
US

IV. Provider business mailing address

400 EAST SYCAMORE STREET
HOLLIS OK
73550
US

V. Phone/Fax

Practice location:
  • Phone: 580-688-2800
  • Fax: 580-688-2193
Mailing address:
  • Phone: 680-688-2800
  • Fax: 580-886-2193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JANET LYNN TIPTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 680-688-2800