NPIMap

Organization Active NPI

Dickerson Memorial Hospital, LLC

  • Rural Acute Care Hospital
  • Jasper, TX
National Provider Identifier
1003939232
Registry record updated Aug 22, 2020
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Key facts

NPPES NPI Registry
Primary specialty
Rural Acute Care HospitalTaxonomy code 282NR1301X
License
007235 Issued in TX
Legal business name
DICKERSON MEMORIAL HOSPITAL, LLC
Practice address
1001 Dickerson Dr
Jasper, TX 75951-5110
Phone
(409) 383-2345
Fax
(281) 447-6802
NPI assigned
Apr 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. John Tatum
Title
Administrator
Phone
(281) 447-6800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Acute Care Hospital 282NR1301X 007235 TX Primary

Addresses

Primary practice location

1001 Dickerson Dr
Jasper, TX 75951-5110

Mailing address

260 N Sam Houston Pkwy E
Suite 220
Houston, TX 77060-2018
Phone (281) 447-6800

Other identifiers 1

IdentifierTypeStateIssuer
HH0400OtherTXBCBS PROVIDER ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Hospital certification: CCN 450206

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MARY E DICKERSON MEMORIAL HOSPITAL
Certification status
Terminated Involuntary: failure to meet health/safety requirements, Dec 28, 1987
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jun 22, 1987
Beds
49 (34 certified)
Ownership / control type
Private (for profit)
Most recent change of ownership
Jun 30, 1982 (1 total)
Facility address
1001 Dickerson Dr
Jasper, TX 75951

Hospital certification: CCN 450838

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
DICKERSON MEMORIAL HOSPITAL
Certification status
Terminated Voluntary: merger or closure, Jul 25, 2008
Provider type (POS)
Hospital – Short-term
Participating since
Nov 30, 2000
Last certification
Jul 24, 2008
Beds
27
Ownership / control type
Private (for profit)
Facility address
1001 Dickerson Drive
Jasper, TX 75951

Hospital certification: CCN 45189E

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
DICKERSON MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital
Participating since
May 8, 2002
Last certification
May 8, 2002
Beds
1
Facility address
1001 Dickerson Drive
Jasper, TX 75951

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003939232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 N SAM HOUSTON PKWY E",
            "address_2": "SUITE 220",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770602018",
            "telephone_number": "281-447-6800",
            "fax_number": "281-447-6802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 DICKERSON DR",
            "city": "JASPER",
            "state": "TX",
            "postal_code": "759515110",
            "telephone_number": "409-383-2345",
            "fax_number": "281-447-6802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DICKERSON MEMORIAL HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TATUM",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "281-447-6800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "TX",
            "license": "007235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER ID",
            "identifier": "HH0400",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jasper, TX

Sources for this page

Verify at the official NPI Registry.