Active NPI
Jacksonville Hospital LLC
- Rural Health Clinic/Center
- Frankston, TX
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rural Health Clinic/Center
- Legal business name
- JACKSONVILLE HOSPITAL LLC
- Practice address
- 580 N Frankston Hwy
Frankston, TX 75763-2516 - Phone
- (903) 876-5888
- Fax
- (903) 876-5889
- NPI assigned
- Feb 10, 2018
- Last updated
- Oct 1, 2023
- Organization subpart
- Yes
- Parent organization
- AHS EAST TEXAS HEALTH SYSTEM, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Stephen C Petrovich
- Title
- Evp
- Phone
- (615) 296-3000
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Primary |
Addresses
Primary practice location
580 N Frankston Hwy
Frankston, TX 75763-2516
Mailing address
340 Seven Springs Way Ste 100
Brentwood, TN 37027-5697
Phone (615) 296-3000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180502000665 | TX | Part A Provider - Rural Health Clinic | 4284996638 | Practice locations: Frankston, TX |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1043719560. Details of each certification follow.
Rural health clinic certification: CCN 458888
- Legal name
- JACKSONVILLE HOSPITAL LLC
- Doing business as
- UT HEALTH EAST TEXAS FRANKSTON PHYSICIAN CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- May 5, 2010
- Last certification
- Nov 8, 2016
- Ownership / control type
- 1B
- Organization structure
- LLC
- Incorporated
- Dec 19, 2017 in DE
- Enrollment address
- 580 N Frankston Hwy
Frankston, TX 75763-2516 - Related CCNs
- 450194
Related certifications (CCN) 1
Facilities connected through Provider of Services related, parent or unit certification numbers.
-
dba UTHealth East Texas Jacksonville Hospital
- General Acute Care Hospital
- Jacksonville, TX
- NPI 1730697350
Parent provider
Other NPIs with the same Medicare PAC ID 3
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba UTHealth East Texas Jacksonville Hospital
- General Acute Care Hospital
- Jacksonville, TX
- NPI 1730697350
4284996638
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2003095 | Jacksonville Hospital, LLC | Certificate of waiver | Jun 3, 2028 |
National Provider Directory
National Provider Directory- Tax ID family
- Jacksonville Hospital LLC
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
dba UTHealth East Texas Jacksonville Hospital
- General Acute Care Hospital
- Jacksonville, TX
- NPI 1730697350
-
- Rural Health Clinic/Center
- Rusk, TX
- NPI 1770082299
-
- Rural Health Clinic/Center
- Jacksonville, TX
- NPI 1861991226
Ownership & related parties
All disclosed owners & managing parties 10
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Ardent Health Inc | 5% Or Greater Indirect Ownership Interest | Mar 1, 2018 | 100% |
| Ahs Texas, LLC | 5% Or Greater Indirect Ownership Interest | Jan 1, 2019 | 100% |
| Martin Bonick | Corporate Officer | Aug 19, 2020 | |
| Mary a Crabtree | Corporate Officer | Mar 1, 2018 | |
| Ahs Management Company Inc. | Operational/Managerial Control | Mar 1, 2018 | 100% |
| Stephen C Petrovich | Corporate Officer | Mar 1, 2018 | |
| Ardent Legacy Holdings LLC | 5% Or Greater Indirect Ownership Interest | Mar 1, 2018 | 100% |
| Ahs East Texas Health System, LLC | 5% Or Greater Direct Ownership Interest | Mar 1, 2018 | 100% |
| Donald Baker | Corporate Officer | Nov 1, 2020 | 100% |
| W-2 Managing Employee | Nov 1, 2020 | 100% | |
| Ahp Health Partners, Inc | 5% Or Greater Indirect Ownership Interest | Mar 1, 2018 | 100% |
Facilities with the same owner 61
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
- General Acute Care Hospital
- Athens, TX
- NPI 1417465824
Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC
-
- General Acute Care Hospital
- Amarillo, TX
- NPI 1407191984
Ahp Health Partners, Inc, Ahs Management Company Inc., Ardent Health Inc, Ardent Legacy Holdings LLC
-
- Rehabilitation Hospital Unit
- Amarillo, TX
- NPI 1730425190
Ahp Health Partners, Inc, Ahs Management Company Inc., Ardent Health Inc, Ardent Legacy Holdings LLC
-
- Rural Health Clinic/Center
- Carthage, TX
- NPI 1407355860
Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC
-
- General Acute Care Hospital
- Carthage, TX
- NPI 1538667035
Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC
-
- Rural Health Clinic/Center
- Carthage, TX
- NPI 1639678030
Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC
-
dba Rehabilitation Hospital of Amarillo
- Rehabilitation Hospital
- Amarillo, TX
- NPI 1487443099
Ahp Health Partners, Inc, Ardent Health Inc, Ardent Legacy Holdings LLC
-
- Rural Health Clinic/Center
- Chandler, TX
- NPI 1235706581
Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC
-
- Rural Health Clinic/Center
- Gun Barrel City, TX
- NPI 1689241945
Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC
-
dba BSA Hospice of the Southwest
- Community Based Hospice Care Agency
- Amarillo, TX
- NPI 1467447854
Ardent Legacy Holdings LLC
-
dba UTHealth East Texas Henderson Hospital
- General Acute Care Hospital
- Henderson, TX
- NPI 1326546797
Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC
-
- Rural Health Clinic/Center
- Henderson, TX
- NPI 1952800310
Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1518220800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1696118400000",
"number": "1043719560",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "340 SEVEN SPRINGS WAY STE 100",
"city": "BRENTWOOD",
"state": "TN",
"postal_code": "370275697",
"telephone_number": "615-296-3000",
"fax_number": "615-296-3227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "580 N FRANKSTON HWY",
"city": "FRANKSTON",
"state": "TX",
"postal_code": "757632516",
"telephone_number": "903-876-5888",
"fax_number": "903-876-5889"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JACKSONVILLE HOSPITAL LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "AHS EAST TEXAS HEALTH SYSTEM, LLC",
"enumeration_date": "2018-02-10",
"last_updated": "2023-10-01",
"certification_date": "2023-10-01",
"status": "A",
"authorized_official_last_name": "PETROVICH",
"authorized_official_first_name": "STEPHEN",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "EVP",
"authorized_official_telephone_number": "615-296-3000"
},
"taxonomies": [
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Frankston, TX
- Halberdent (Frankston Family Dentistry)
- Kyle William Halberstadt, D.D.S.
- Amanda Gayle Hefelfinger, RN
- Courtney Holcomb, FNP
- Hospitality Health Care Services
- Debra Jo Johnson, LPC,LPA
- Larry Kelly Lummus, D.D.S.
- Christina Martin, PHARMD
- Maxwell Pharmacy Inc (Maxwell Pharmacy)
- Joseph M Maxwell Jr., R.PH.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.