NPIMap

Organization Active NPI

Jackson County Memorial Hospital Authority

  • Critical Access Hospital
  • Hollis, OK
National Provider Identifier
1003094129
Registry record updated Oct 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY
Practice address
400 E Chestnut St
Hollis, OK 73550-2030
Phone
(580) 688-3363
Fax
(580) 688-9730
NPI assigned
Jan 31, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Steve Hartgraves
Title
President/Ceo
Phone
(580) 379-5500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X Primary

Addresses

Primary practice location

400 E Chestnut St
Hollis, OK 73550-2030

Mailing address

400 E Chestnut St
P.O. Box 791
Hollis, OK 73550-2030
Phone (580) 688-3363

Other identifiers 1

IdentifierTypeStateIssuer
37Z338OtherMEDICARE ID

Other names 1

  • Harmon Memorial Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190611003408 OK Part A Provider - Critical Access Hospital 1759293178 Practice locations: Hollis, OK

Hospital certification: CCN 37Z338

Legal name
JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY
Doing business as
HARMON MEMORIAL HOSPITAL
Organization structure
OtherNon-profit
Enrollment address
400 E Chestnut St
Hollis, OK 73550-2030
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
J C M H11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

400 E Chestnut St
Hollis, OK 73550
Phone (580) 471-0971

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Corwin Petzold Individual Corporate DirectorBoard Member Aug 13, 2013
Matt Coppock Individual Corporate DirectorBoard Member Mar 24, 2014
Jackson County Memorial Hospital Authority Organization, Altus, OK 5% Or Greater Direct Ownership Interest Mar 1, 2019 100%
Elizabeth Renee Whiting Individual W-2 Managing EmployeeVP Bus Intel/Strategic Analytics Apr 5, 1999
Ernest Harold James Individual Corporate Director Jul 1, 2022
Gary Beach Individual Corporate DirectorBoard Member Aug 11, 2014
Steven L Hartgraves Individual Corporate OfficerPresident/Ceo Apr 22, 2014
Corporate DirectorPresident/Ceo Mar 24, 2014
W-2 Managing EmployeePresident/Ceo Mar 24, 2014
David Brown Individual Corporate DirectorBoard Member Jan 25, 2016
Mary Beth Hawkins Individual Corporate Director Jul 1, 2020
Carrol Holder Individual Corporate Director Jul 1, 2022
Joe Max Freeman Individual Corporate DirectorBoard Member Oct 14, 2025

Owners & managing parties with NPI records 8

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Jackson County Memorial HospitalAltus, OK, CCN 370022 Hospital 5% Or Greater Direct Ownership Interest Jul 1, 2010
Jackson County Memorial HospitalAltus, OK, CCN 37U022 Hospital 5% Or Greater Direct Ownership Interest Jul 1, 2010
Harmon Memorial HospitalHollis, OK, CCN 371338 Hospital 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2019
Jackson County Memorial Hospital HospiceAltus, OK, CCN 377137 Home health agency Operational/Managerial Control (100%) Feb 1, 2012
Jackson County Memorial Hospital HospiceAltus, OK, CCN 371540 Hospice Operational/Managerial Control Jan 1, 2008

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665014400000",
    "number": "1003094129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E CHESTNUT ST",
            "address_2": "P.O. BOX 791",
            "city": "HOLLIS",
            "state": "OK",
            "postal_code": "735502030",
            "telephone_number": "580-688-3363",
            "fax_number": "580-688-9730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E CHESTNUT ST",
            "city": "HOLLIS",
            "state": "OK",
            "postal_code": "735502030",
            "telephone_number": "580-688-3363",
            "fax_number": "580-688-9730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-31",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A",
        "authorized_official_last_name": "HARTGRAVES",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "580-379-5500"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "37Z338",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harmon Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hollis, OK

Sources for this page

Verify at the official NPI Registry.