NPIMap

Organization Active NPI

Methodist Hospital Levelland

Doing business as Levelland Clinic North

  • Rural Health Clinic/Center
  • Levelland, TX
National Provider Identifier
1083602940
Registry record updated May 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
000307 Issued in TX
Legal business name
METHODIST HOSPITAL LEVELLAND
Doing business as
Levelland Clinic North
Practice address
103 John Dupree Dr
Levelland, TX 79336-6326
Phone
(806) 894-2465
Fax
(806) 894-8897
NPI assigned
Oct 13, 2005
Last updated
May 6, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
METHODIST HOSPITAL LEVELLANDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 6, 2025

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

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary of Enrollments
Phone
(425) 358-9786

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 000307 TX
Obstetrics & Gynecology Physician 207V00000X 000307 TX
Rural Health Clinic/Center 261QR1300X 000307 TX Primary

Addresses

Primary practice location

103 John Dupree Dr
Levelland, TX 79336-6326

Mailing address

PO Box 677044
Dallas, TX 75267-7044
Phone (806) 894-2465

Other identifiers 2

IdentifierTypeStateIssuer
00K60VOtherTXBCBS
144130502MedicaidTX

Other names 1

  • Levelland Clinic North Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120313000485 TX Part A Provider - Rural Health Clinic 8527041037 Practice locations: Levelland, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083602940. Details of each certification follow.

Rural health clinic certification: CCN 458815

Legal name
METHODIST HOSPITAL LEVELLAND
Doing business as
LEVELLAND CLINIC NORTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 20, 2001
Last certification
Feb 13, 2018
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Aug 4, 1998 in TX
Enrollment address
103 John Dupree Dr
Levelland, TX 79336-6326
Related CCNs
450755

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

Other NPIs with the same Medicare PAC ID 5

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D0890553Levelland Clinic North -103 John Dupre Drive, Levelland, TX 79336Certificate of waiverJan 8, 2027

National Provider Directory

National Provider Directory
Tax ID family
Methodist Hosp Levellan4 organizations share this tax ID, including this one
Part of
Methodist Hosp Levellan

Other organizations with this tax ID 3

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Kathleen Burrell Individual Corporate OfficerCorporate Secretary Mar 1, 2023
Newman Wheeler Individual Corporate OfficerCeo Feb 14, 2022
Corporate DirectorBoard Member Jan 1, 2023
Michael G Bailey Individual Corporate DirectorBoard Member Jan 1, 2023
Joel B White Individual Corporate DirectorBoard Member Oct 1, 2025
Rebecca Currington Individual Corporate DirectorBoard Member Jan 1, 2022
Providence Health & Services - Washington Organization, Renton, WA Corporation, Non-profit Operational/Managerial Control Aug 1, 2020
Lisa Guzman Individual Corporate DirectorBoard Member Feb 23, 2023
Covenant Health System Organization, Lubbock, TX Corporation, Non-profit Other Aug 13, 1988
Cora Rivera Individual Corporate OfficerCfo Oct 31, 2023
Lubbock Methodist Hospital System Organization, Lubbock, TX Corporation, Non-profit Other Apr 1, 1999 43%
Deette Edens Individual Corporate DirectorBoard Member Jan 1, 2023
Crystal Gonzales Individual W-2 Managing EmployeeClinic Supervisor Aug 13, 1988 100%
Johnathon Morin Individual W-2 Managing EmployeeManager Clinical Services Sep 30, 2019
Kenneth Shipley Individual Corporate DirectorBoard Member Jan 1, 2023
Donald Wayne Anderson Individual Corporate OfficerAssistant Secretary of Enrollments Sep 1, 2020
Gregory David Hoffman Individual Corporate OfficerCfo/Treasurer Jan 1, 2023
St. Joseph Health System Organization, Irvine, CA Corporation, Non-profit Other Jul 1, 1998 57%
Dyana Kerr Individual W-2 Managing EmployeeRegional Financial Executive Mar 1, 2023
Providence St. Joseph Health Organization, Renton, WA Corporation, Non-profit Other Jul 1, 2016

Owners & managing parties with NPI records 3

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

Facilities with the same owner 139

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

View all 139

NPI Registry JSON

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

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746489600000",
    "number": "1083602940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 677044",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752677044",
            "telephone_number": "806-894-2465",
            "fax_number": "806-894-8897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 JOHN DUPREE DR",
            "city": "LEVELLAND",
            "state": "TX",
            "postal_code": "793366326",
            "telephone_number": "806-894-2465",
            "fax_number": "806-894-8897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METHODIST HOSPITAL LEVELLAND",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "METHODIST HOSPITAL LEVELLAND",
        "enumeration_date": "2005-10-13",
        "last_updated": "2025-05-06",
        "certification_date": "2025-05-06",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "000307",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "000307",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "TX",
            "license": "000307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00K60V",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "144130502",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Levelland Clinic North",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Levelland Clinic North",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Levelland, TX

Sources for this page

Verify at the official NPI Registry.