NPIMap

Organization Active NPI

Andrews County Hospital District

Doing business as Andrews Family Medicine

  • Rural Health Clinic/Center
  • Andrews, TX
National Provider Identifier
1124054069
Registry record updated Jul 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ANDREWS COUNTY HOSPITAL DISTRICT
Doing business as
Andrews Family Medicine
Practice address
700 Hospital Dr
Andrews, TX 79714-3638
Phone
(432) 523-6624
Fax
(432) 523-7901
NPI assigned
Jun 23, 2006
Last updated
Jul 31, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
ANDREWS COUNTY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 31, 2026

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

Authorized official

Name
Susan Fournier
Title
Cfo
Phone
(432) 464-2107

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 000183 TX
Internal Medicine Physician 207R00000X
Obstetrics & Gynecology Physician 207V00000X
Rural Health Clinic/Center 261QR1300X Primary
Nurse Practitioner 363L00000X

Addresses

Primary practice location

700 Hospital Dr
Andrews, TX 79714-3638

Mailing address

700 Hospital Dr
Andrews, TX 79714-3638
Phone (432) 523-6624

Other identifiers 1

IdentifierTypeStateIssuer
112273103MedicaidTX

Other names 1

  • ANDREWS FAMILY MEDICINE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100521000268 TX Part A Provider - Rural Health Clinic 6002724945 Practice locations: Andrews, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124054069. Details of each certification follow.

Rural health clinic certification: CCN 458655

Legal name
ANDREWS COUNTY HOSPITAL DISTRICT
Doing business as
ANDREWS FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 13, 1995
Last certification
Sep 6, 2017
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
700 Hospital Dr
Andrews Family Medicine
Andrews, TX 79714-3638
Related CCNs
450144

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

Other NPIs with the same Medicare PAC ID 8

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
45D0858613Andrews Family Medicine RHC700 Hospital Drive, Andrews, TX 79714Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Permian General Hospita9 organizations share this tax ID, including this one
Part of
Permian General Hospita

Other organizations with this tax ID 8

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

Locations

714 Hospital Dr
Andrews, TX 79714
Phone (432) 464-2415

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Manual Gonzales Individual Corporate DirectorBoard Member Jan 31, 2017
Morgan Mason Individual Corporate OfficerChief Financial Officer Jan 1, 2021
W-2 Managing EmployeeChief Financial Officer Jan 1, 2020
Carol Boswell Individual Corporate DirectorBoard Member May 1, 2022
Donny Booth Individual W-2 Managing EmployeeCeo Jul 1, 2012
Melody Starcher Individual W-2 Managing Employee Oct 18, 2022
Andrea Warnke Individual Corporate DirectorBoard Member May 31, 2018
Elizabeth Boynton Individual Corporate Director May 26, 2010
Christopher Dallaire Individual W-2 Managing EmployeeClinic Director Jun 29, 2020
Jessica Varner Individual Corporate DirectorBoard Member May 1, 2022
Andrews County Hospital District Organization, Andrews, TX Operational/Managerial Control May 26, 2010
Sarah Bender Individual Corporate DirectorBoard Member Nov 1, 2023
Mike Sanchez Individual Corporate DirectorBoard Member Nov 1, 2020

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Permian Regional Medical CenterAndrews, TX, CCN 450144 Hospital Operational/Managerial Control Jan 1, 2003
Permian Regional Medical CenterAndrews, TX, CCN 45U144 Hospital Operational/Managerial Control Jan 1, 2003
Permian Residential Care CenterAndrews, TX, CCN 676175 Skilled nursing facility 5% Or Greater Direct Ownership Interest
Trustee of the SNF
Adp of the SNF		 Feb 12, 2003
Feb 12, 2003
Feb 12, 2003
Permian Regional Medical Center Home HealthAndrews, TX, CCN 457596 Home health agency Operational/Managerial Control Nov 1, 2009
Quick Care ClinicAndrews, TX, CCN 673420 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 2, 2013

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 5

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

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785456000000",
    "number": "1124054069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 HOSPITAL DR",
            "city": "ANDREWS",
            "state": "TX",
            "postal_code": "797143638",
            "telephone_number": "432-523-6624",
            "fax_number": "432-523-7901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 HOSPITAL DR",
            "city": "ANDREWS",
            "state": "TX",
            "postal_code": "797143638",
            "telephone_number": "432-523-6624",
            "fax_number": "432-523-7901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDREWS COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ANDREWS COUNTY HOSPITAL DISTRICT",
        "enumeration_date": "2006-06-23",
        "last_updated": "2026-07-31",
        "certification_date": "2026-07-31",
        "status": "A",
        "authorized_official_last_name": "FOURNIER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "432-464-2107"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "000183",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112273103",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ANDREWS FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ANDREWS FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Andrews, TX

Sources for this page

Verify at the official NPI Registry.