NPIMap

Organization Active NPI

Throckmorton County Memorial Hosp

  • Rural Health Clinic/Center
  • Throckmorton, TX
National Provider Identifier
1114047875
Registry record updated Dec 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
THROCKMORTON COUNTY MEMORIAL HOSP
Practice address
802 N Minter Ave Ste B
Throckmorton, TX 76483-5357
Phone
(940) 849-2151
Fax
(940) 849-7141
NPI assigned
Mar 29, 2007
Last updated
Dec 8, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2017

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

Authorized official

Name
Mr. Kirby A Gober, DVM
Title
Ceo
Phone
(940) 849-2151

Specialties & licenses 1

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

Addresses

Primary practice location

802 N Minter Ave Ste B
Throckmorton, TX 76483-5357

Mailing address

PO Box 729
Throckmorton, TX 76483-0729
Phone (940) 849-2151

Other identifiers 2

IdentifierTypeStateIssuer
0635682-01MedicaidTX
0635682-02MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040809000910 TX Part B Supplier - Clinic/Group Practice 4082686282 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
Practice locations: Throckmorton, TX
O20100715000796 TX Part A Provider - Rural Health Clinic 4082686282 Practice locations: Throckmorton, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114047875. Details of each certification follow.

Rural health clinic certification: CCN 458683

Legal name
THROCKMORTON COUNTY MEMORIAL HOSP
Doing business as
THROCKMORTON RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 7, 1996
Last certification
Jan 6, 2016
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
802 N Minter Ave Ste B
Throckmorton, TX 76483-5357
Related CCNs
451339

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
45D1002214Throckmorton Rural Health Clinic802 Minter, Suite B, Throckmorton, TX 76483Certificate of waiverJul 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Throckmorton County Mem2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

802 N Minter Ave
#B
Throckmorton, TX 76483
Phone (940) 849-2151

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Karla Benson Individual W-2 Managing EmployeeBusiness Office Manager Nov 1, 2013
Kirby Gober Individual Corporate OfficerCeo Jun 20, 2014
Throckmorton County Memorial Hosp Organization, Throckmorton, TX Operational/Managerial Control Jun 29, 2010

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Throckmorton County Memorial HospThrockmorton, TX, CCN 451339 Hospital Operational/Managerial Control Nov 12, 2010
Throckmorton County Memorial HospThrockmorton, TX, CCN 45Z339 Hospital Operational/Managerial Control Nov 12, 2010

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 2

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512691200000",
    "number": "1114047875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 729",
            "city": "THROCKMORTON",
            "state": "TX",
            "postal_code": "764830729",
            "telephone_number": "940-849-2151",
            "fax_number": "940-849-7141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 N MINTER AVE STE B",
            "city": "THROCKMORTON",
            "state": "TX",
            "postal_code": "764835357",
            "telephone_number": "940-849-2151",
            "fax_number": "940-849-7141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THROCKMORTON COUNTY MEMORIAL HOSP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2017-12-08",
        "status": "A",
        "authorized_official_last_name": "GOBER",
        "authorized_official_first_name": "KIRBY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "940-849-2151",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DVM"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0635682-01",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0635682-02",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Throckmorton, TX

Sources for this page

Verify at the official NPI Registry.