Jack County Hospital District
Organization Active NPI Ambulatory Surgical Clinic/Center · Jacksboro, TX
NPI 1154419612 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1154419612
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulatory Surgical Clinic/Center 261QA1903X
- License
- 119874903 (TX)
- Legal business name
- JACK COUNTY HOSPITAL DISTRICT
- Practice address
- 215 Chisholm TRL
Jacksboro, TX 76458-1403 - Phone
- (940) 567-6633
- Fax
- (940) 567-2895
- NPI assigned
- Oct 10, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Kim Lee
- Title
- Coo
- Phone
- (940) 567-6633
Owners & managing parties with NPI records 2
Other NPIs on the same Medicare enrollment 1
Member organizations 6
Related certifications (CCN) 6
Affiliated clinicians 74
-
Shivum Agarwal, M.D.
-
Joseph Agnew, M.D.
-
Jennifer Archer, DO
-
Jack Charles Askins, M. D.
-
Meria G Aulds, MD
-
Iftikhar Burney, MD
-
Ariel Ann-Ski Carter, APRN, FNP-C
-
Jessica Coker, APRN, FNP
-
John Colbath, DO
-
Amy Danielle Cosgrove, M.D.
-
Saritha Dodla, M.D.
-
Claressa Donley, FNP
-
Katherine Dowd, MD
-
Joshua Mark Evans, D.O.
-
Jessa C Foster, FNP
-
Cathy Gresham, FNP-BC
-
Michael A Hames, M.D.
-
Syed N Hussain, MBBS
Medicare Care Compare: Hospital
- Listed as
- Faith Community Hospital
- Type
- Acute Care Hospitals
- Ownership
- Government - Hospital District or Authority
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Hospital certification: CCN 450241
- Legal name
- JACK COUNTY HOSPITAL DISTRICT
- Doing business as
- FAITH COMMUNITY HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Apr 20, 2022
- Beds
- 41
- Ownership / control type
- Hospital district or authority
- Organization structure
- Government · Non-profit
- Enrollment address
- 215 Chisholm Trail
Jacksboro, TX 76458-1403 - Hospital subgroups
- General, Acute care
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| James Hammond |
Corporate Director |
Jan 1, 2015 | |
| Mark Maples |
Corporate Director | Aug 25, 2010 | |
| Lori McBrayer |
Corporate Director |
Jan 1, 2015 | |
| Leslie Chalmers |
Corporate Director |
Jan 1, 2020 | |
| Larry Hopwood |
Corporate Director |
Jan 1, 2015 | |
| Jack County Hospital District |
Operational/Managerial Control | Aug 25, 2010 | |
| Kim Lee |
Corporate Director |
Oct 1, 2024 | |
| Frank L Beaman |
Corporate Director |
Sep 27, 2012 | |
| W-2 Managing Employee | Jan 20, 2011 | ||
| Trina D Johnson |
W-2 Managing Employee |
Oct 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100827000915 | TX | Part a Provider - Hospital | 5890768675 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bowie, TX; Jacksboro, TX |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | 119874903 | TX | Yes |
Addresses
Primary practice location
215 Chisholm TRL
Jacksboro, TX 76458-1403
Mailing address
215 Chisholm TRL
Jacksboro, TX 76458-1403
Phone (940) 567-6633
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 119874903 | Medicaid | TX |
Other names
- faith community hospital amb surg
Other providers in Jacksboro, TX
- James Rodney Hammond
- Rhonda Joleen Hansen
- Hayden Behling PA-C & Company
- Babu Hosakote Subrahmanyam
- Jack County Hospital District
- Jack County Hospital District
- Jack County Hospital District
- Jack County Hospital District
- Jack County Hospital District
- Jacksboro Assisted Living, Inc.
All providers in Jacksboro, TX · Ambulatory Surgical Clinic/Center in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.