NPIMap

Organization Active NPI

Shackelford County Community Resource Center

Doing business as ResourceCare Clyde

  • Federally Qualified Health Center (FQHC)
  • Clyde, TX
National Provider Identifier
1215205265
Registry record updated Oct 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
30117281979 Issued in TX
Legal business name
SHACKELFORD COUNTY COMMUNITY RESOURCE CENTER
Doing business as
ResourceCare Clyde
Practice address
1712 North Access Road
Clyde, TX 79510
Phone
(325) 893-4010
Fax
(325) 893-4035
NPI assigned
Dec 6, 2011
Last updated
Oct 30, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2012

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

Authorized official

Name
Mrs. Tina Louise Betcher
Title
Billing Manager/Credentialer
Phone
(325) 893-4010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 30117281979 TX Primary

Addresses

Primary practice location

1712 North Access Road
Clyde, TX 79510

Mailing address

PO Box 2435
Albany, TX 76430-8020
Phone (325) 762-2447

Other identifiers 1

IdentifierTypeStateIssuer
287755701MedicaidTX

Other names 1

  • ResourceCare Clyde Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120131000925 OK Part A Provider - Federally Qualified Health Center (FQHC) 8628027174 Practice locations: Clyde, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215205265. Details of each certification follow.

Federally qualified health center certification: CCN 671976

Legal name
SHACKELFORD COUNTY COMMUNITY RESOURCE CENTER
Doing business as
RESOURCECARE CLYDE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 1, 2012
Last certification
Mar 1, 2012
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jun 16, 1994 in TX
Enrollment address
1712 North Access Road
Resourcecare Clyde
Clyde, TX 79510-3352

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Shackelford County Community Resource Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Eileen Piwetz Individual Corporate DirectorMember of the Board of Directors Oct 27, 2022
Sylvia Robinson Individual Corporate Director Aug 1, 2023
Rea Barry Individual Corporate Director Nov 1, 2023
Jeanie F Stephens Individual Corporate DirectorBoard Secretary Feb 1, 2012
Ryan Wade Individual Corporate DirectorCfo May 27, 2025
W-2 Managing EmployeeAd; May 27, 2025
Joel S Deel Individual Corporate DirectorVice President Board of Directors Oct 22, 2015
William W Thompson Individual Corporate DirectorBoard President Oct 28, 2021
Scott Clifford Byrd Individual Corporate DirectorMember of the Board of Directors Oct 28, 2021
Kathleen Tippy Individual Corporate DirectorMember of the Board of Directors Oct 22, 2020
Jeff D Graham Individual Corporate DirectorBoard of Director Treasurer Jun 25, 2015
Amy Kelly Individual Corporate DirectorBoard Member Oct 26, 2017
Joanne C Paulk Individual W-2 Managing EmployeeChief Medical Officer Oct 1, 2022
David Estes Individual Corporate DirectorMember of the Board of Directors Oct 27, 2022
Shackelford County Community Resource Center Organization, Albany, TX Operational/Managerial Control Feb 1, 2012
Carrol Kanady Individual Corporate DirectorBoard Member Dec 17, 2020
Tina L Betcher Individual W-2 Managing EmployeeBilling Manager Feb 1, 2012
Joel Johnson Individual Corporate DirectorMember of the Board of Directors Oct 27, 2022
Phillip Rodriguez Individual Corporate Director Nov 1, 2023

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Resourcecare BairdBaird, TX, CCN 671909 Federally qualified health center Operational/Managerial Control Jun 1, 2011

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

NPI Registry JSON

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

{
    "created_epoch": "1323129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351555200000",
    "number": "1215205265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2435",
            "city": "ALBANY",
            "state": "TX",
            "postal_code": "764308020",
            "telephone_number": "325-762-2447",
            "fax_number": "325-762-2186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1712 NORTH ACCESS ROAD",
            "city": "CLYDE",
            "state": "TX",
            "postal_code": "79510",
            "telephone_number": "325-893-4010",
            "fax_number": "325-893-4035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHACKELFORD COUNTY COMMUNITY RESOURCE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-06",
        "last_updated": "2012-10-30",
        "status": "A",
        "authorized_official_last_name": "BETCHER",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "BILLING MANAGER/CREDENTIALER",
        "authorized_official_telephone_number": "325-893-4010",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "TX",
            "license": "30117281979",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287755701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ResourceCare Clyde",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clyde, TX

Sources for this page

Verify at the official NPI Registry.