Healthcare Provider Details

I. General information

NPI: 1104768308
Provider Name (Legal Business Name): SHORTGRASS COMMUNITY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 WATTS ST
SAYRE OK
73662-1312
US

IV. Provider business mailing address

1505 WATTS ST
SAYRE OK
73662-1312
US

V. Phone/Fax

Practice location:
  • Phone: 580-928-2222
  • Fax: 580-928-9605
Mailing address:
  • Phone: 580-928-2222
  • Fax: 580-928-9605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
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: 580-688-2800