NPIMap

Organization Active NPI

Comanche County Medical Center Company

Doing business as Doctors Medical Center

  • Rural Health Clinic/Center
  • Comanche, TX
National Provider Identifier
1114221199
Registry record updated Apr 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
11111 Issued in TX
Legal business name
COMANCHE COUNTY MEDICAL CENTER COMPANY
Doing business as
Doctors Medical Center
Practice address
10201 Highway 16
Comanche, TX 76442-4462
Phone
(254) 879-4910
NPI assigned
Jan 5, 2011
Last updated
Apr 30, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2012

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

Authorized official

Name
Mr. Kevin Storey
Title
Ceo
Phone
(254) 879-4900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 11111 TX Primary

Addresses

Primary practice location

10201 Highway 16
Comanche, TX 76442-4462

Mailing address

10201 Highway 16
Comanche, TX 76442-4462
Phone (254) 879-4910

Other identifiers 2

IdentifierTypeStateIssuer
092950702MedicaidTX
OOU50BOtherTXBCBS

Other names 1

  • Doctors Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110212000129 TX Part A Provider - Rural Health Clinic 3678753357 Practice locations: Comanche, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114221199. Details of each certification follow.

Rural health clinic certification: CCN 458562

Legal name
COMANCHE COUNTY MEDICAL CENTER COMPANY
Doing business as
DOCTORS MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 1, 1994
Last certification
Apr 6, 2016
Ownership / control type
1B
Most recent change of ownership
Jun 29, 2002 (1 total)
Organization structure
OtherNon-profit
Incorporated
in TX
Enrollment address
10201 Highway 16
Comanche, TX 76442-4462

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Comanche County Med Ctr7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Member organizations 4

Organizations listed as members of this organization in the National Provider Directory.

Locations

408 N Austin St
Comanche, TX 76442
Phone (325) 356-1135

1870 Highway 36 W
Rising Star, TX 76471

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
Hong C Wade Individual Corporate OfficerCfo Dec 9, 2019
Daniel Bonk Individual Corporate OfficerCeo Sep 21, 2025
W-2 Managing EmployeeCeo Sep 21, 2025
Tamra Wells Individual W-2 Managing EmployeeProvider Enrollment Jun 1, 2014

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1294185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335744000000",
    "number": "1114221199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10201 HIGHWAY 16",
            "city": "COMANCHE",
            "state": "TX",
            "postal_code": "764424462",
            "telephone_number": "254-879-4910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10201 HIGHWAY 16",
            "city": "COMANCHE",
            "state": "TX",
            "postal_code": "764424462",
            "telephone_number": "254-879-4910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMANCHE COUNTY MEDICAL CENTER COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-05",
        "last_updated": "2012-04-30",
        "status": "A",
        "authorized_official_last_name": "STOREY",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "254-879-4900",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "TX",
            "license": "11111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092950702",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "OOU50B",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Doctors Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Comanche, TX

Sources for this page

Verify at the official NPI Registry.