NPIMap

Organization Active NPI

Muleshoe Area Hospital District

Doing business as Medical Clinic of Muleshoe

  • Rural Health Clinic/Center
  • Muleshoe, TX
National Provider Identifier
1104810522
Registry record updated Feb 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
000631 Issued in TX
Legal business name
MULESHOE AREA HOSPITAL DISTRICT
Doing business as
Medical Clinic of Muleshoe
Practice address
701 S 1St St
Muleshoe, TX 79347-3626
Phone
(806) 272-7531
Fax
(806) 272-4749
NPI assigned
Aug 31, 2005
Last updated
Feb 2, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MULESHOE AREA HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 2, 2024

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

Authorized official

Name
Mr. Dennis Fleenor
Title
Ceo/Administrator
Phone
(806) 272-4524

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 000631 TX Primary

Addresses

Primary practice location

701 S 1St St
Muleshoe, TX 79347-3626

Mailing address

708 S 1St St
Muleshoe, TX 79347-3627
Phone (806) 272-4524

Other names 1

  • Medical Clinic of Muleshoe Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240314001825 TX Part A Provider - Rural Health Clinic 8820906167 Practice locations: Muleshoe, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104810522. Details of each certification follow.

Rural health clinic certification: CCN 673430

Legal name
MULESHOE AREA HOSPITAL DISTRICT
Doing business as
MEDICAL CLINIC OF MULESHOE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 17, 2015
Last certification
Aug 22, 2023
Ownership / control type
1B
Most recent change of ownership
Mar 1, 2024 (1 total)
Organization structure
OtherNon-profit
Enrollment address
701 S 1St St
Muleshoe, TX 79347-3626
Related CCNs
451372

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

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Part of
Muleshoe Area Hospital

Member of 1

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

Locations

708 S 1st St
Bldg 2
Muleshoe, TX 79347
Phone (806) 272-4524

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Robbie Dewberry Individual Corporate DirectorChief Financial Officer Nov 1, 2023
W-2 Managing EmployeeChief Financial Officer Nov 1, 2023
Allen Allen Smyer Individual Corporate OfficerBoard President Dec 29, 2011
Landon Nichols Individual Corporate OfficerBoard Vice President May 24, 2012
Scott Miller Individual Corporate OfficerBoard Member May 26, 2022
Muleshoe Area Hospital District Organization, Muleshoe, TX Operational/Managerial Control Mar 1, 2024
Gayle Richerson Individual Corporate OfficerBoard Secretary May 25, 2023
Dennis J Fleenor Individual Corporate DirectorChief Executive Officer Mar 3, 2016
W-2 Managing EmployeeChief Executive Officer Mar 3, 2016

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Muleshoe Area Medical CenterMuleshoe, TX, CCN 451372 Hospital Operational/Managerial Control Mar 1, 2024
Muleshoe Area Medical CenterMuleshoe, TX, CCN 45Z372 Hospital Operational/Managerial Control Mar 1, 2024
Park View Nursing Care CenterMuleshoe, TX, CCN 676079 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2006

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

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

Change-of-ownership history 1

DateEventCounterparty
Mar 1, 2024 Change of OwnershipThis provider was the buyer Medical Clinic of MuleshoeCCN 673430, TX, NPI 1821484320

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706832000000",
    "number": "1104810522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 S 1ST ST",
            "city": "MULESHOE",
            "state": "TX",
            "postal_code": "793473627",
            "telephone_number": "806-272-4524",
            "fax_number": "806-272-4938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 S 1ST ST",
            "city": "MULESHOE",
            "state": "TX",
            "postal_code": "793473626",
            "telephone_number": "806-272-7531",
            "fax_number": "806-272-4749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MULESHOE AREA HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MULESHOE AREA HOSPITAL DISTRICT",
        "enumeration_date": "2005-08-31",
        "last_updated": "2024-02-02",
        "certification_date": "2024-02-02",
        "status": "A",
        "authorized_official_last_name": "FLEENOR",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "CEO/ADMINISTRATOR",
        "authorized_official_telephone_number": "806-272-4524",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "TX",
            "license": "000631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Clinic of Muleshoe",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Muleshoe, TX

Sources for this page

Verify at the official NPI Registry.