NPIMap

Organization Active NPI

Preferred Hospital Leasing Van Horn Inc

  • Medicare Defined Swing Bed Hospital Unit
  • Van Horn, TX
National Provider Identifier
1124172374
Registry record updated Sep 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
008172 Issued in TX
Legal business name
PREFERRED HOSPITAL LEASING VAN HORN INC
Practice address
Eisenhower-FM 2185
Van Horn, TX 79855-0609
Phone
(432) 283-2760
Fax
(432) 283-2581
NPI assigned
Jan 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2009

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

Authorized official

Name
Donald Freeman
Title
President
Phone
(405) 878-0202

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 008172 TX Primary

Addresses

Primary practice location

Eisenhower-FM 2185
Van Horn, TX 79855-0609

Mailing address

PO Box 609
Van Horn, TX 79855-0609
Phone (432) 283-2760

Other names 1

  • Culberson Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071221000209 TX Part A Provider - Critical Access Hospital 1456381540 Practice locations: Van Horn, TX

Hospital certification: CCN 45Z338

Legal name
PREFERRED HOSPITAL LEASING VAN HORN INC
Doing business as
CULBERSON HOSPITAL
Organization structure
CorporationProprietary
Incorporated
Jul 8, 2004 in OK
Enrollment address
Eisenhower & Farm Market Road 2185
Van Horn, TX 76955-0609
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Preferred Hospital Leasing Van Horn Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Donald a Freeman Individual 5% Or Greater Direct Ownership Interest Aug 1, 2004 100%
Corporate OfficerPresident Aug 1, 2004 100%
Preferred Management Corporation Organization, Shawnee, OK For-profit Operational/Managerial Control Aug 1, 2004
Rick Gray Individual W-2 Managing EmployeeAdministrator Nov 15, 2018
Karla a Betterton Individual Corporate OfficerVice President of Finance Aug 1, 2004
Jared Chanski Individual Corporate OfficerVice President of Operations Jan 1, 2019
Josh Tucker Individual Corporate OfficerChief Financial Officer Dec 1, 2017

Facilities with the same owner 35

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

View all 35

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254268800000",
    "number": "1124172374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 609",
            "city": "VAN HORN",
            "state": "TX",
            "postal_code": "798550609",
            "telephone_number": "432-283-2760",
            "fax_number": "432-283-2581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "EISENHOWER-FM 2185",
            "city": "VAN HORN",
            "state": "TX",
            "postal_code": "798550609",
            "telephone_number": "432-283-2760",
            "fax_number": "432-283-2581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREFERRED HOSPITAL LEASING VAN HORN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2009-09-30",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "405-878-0202"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "TX",
            "license": "008172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Culberson Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Van Horn, TX

Sources for this page

Verify at the official NPI Registry.