NPIMap

Organization Active NPI

Jackson County Memorial Hospital Authority

  • Community Based Hospice Care Agency
  • Altus, OK
National Provider Identifier
1235170754
Registry record updated Oct 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
4040 Issued in OK
Legal business name
JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY
Practice address
1204 E Tamarack Rd
Altus, OK 73521-1234
Phone
(580) 379-6900
Fax
(580) 379-6909
NPI assigned
Jun 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2022

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

Authorized official

Name
Mr. Steve Hartgraves
Title
President/Ceo
Phone
(580) 379-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 4040 OK Primary

Addresses

Primary practice location

1204 E Tamarack Rd
Altus, OK 73521-1234

Mailing address

1204 E Tamarack Rd
Altus, OK 73521-1234
Phone (580) 379-6900

Other names 1

  • Jackson County Memorial Hospital Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071106000222 OK Part A Provider - Hospice 1759293178 Practice locations: Altus, OK

Hospice certification: CCN 371540

Legal name
JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY
Doing business as
JACKSON COUNTY MEMORIAL HOSPITAL HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Apr 13, 1995
Last certification
Dec 8, 2020
Ownership / control type
Non-Profit - Other
Organization structure
OtherNon-profit
Enrollment address
1204 E Tamarack Rd
Jackson County Mem Hosp Hospice
Altus, OK 73521-1234

Other NPIs with the same Medicare PAC ID 8

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Jackson County Memorial Hospital AuthorityCCN 371540
Ownership
Government
Certified
Apr 13, 1995
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
J C M H11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Corwin Petzold Individual Corporate DirectorBoard Member Aug 13, 2013
Matt Coppock Individual Corporate DirectorBoard Member Mar 24, 2014
Jackson County Memorial Hospital Authority Organization, Altus, OK Operational/Managerial Control Jan 1, 2008
Elizabeth Renee Whiting Individual W-2 Managing Employee Nov 16, 2011
Ernest Harold James Individual Corporate DirectorBoard Member Jul 1, 2022
Gary Beach Individual Corporate DirectorBoard Member Aug 11, 2014
Steven L Hartgraves Individual Contracted Managing Employee Mar 15, 2014
Corporate Director Mar 15, 2014
David Brown Individual Corporate DirectorBoard Member Jan 25, 2016
Mary Beth Hawkins Individual Corporate DirectorBoard Member Jul 1, 2020
Carrol Holder Individual Corporate DirectorBoard Member Jul 1, 2022
Joe Max Freeman Individual Corporate DirectorBoard Member Oct 14, 2025

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
Jackson County Memorial HospitalAltus, OK, CCN 370022 Hospital 5% Or Greater Direct Ownership Interest Jul 1, 2010
Jackson County Memorial HospitalAltus, OK, CCN 37U022 Hospital 5% Or Greater Direct Ownership Interest Jul 1, 2010
Harmon Memorial HospitalHollis, OK, CCN 371338 Hospital 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2019
Harmon Memorial HospitalHollis, OK, CCN 37Z338 Hospital 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2019
Jackson County Memorial Hospital HospiceAltus, OK, CCN 377137 Home health agency Operational/Managerial Control (100%) Feb 1, 2012

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Affiliated clinicians 7

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": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665014400000",
    "number": "1235170754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 E TAMARACK RD",
            "city": "ALTUS",
            "state": "OK",
            "postal_code": "735211234",
            "telephone_number": "580-379-6900",
            "fax_number": "580-379-6909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 E TAMARACK RD",
            "city": "ALTUS",
            "state": "OK",
            "postal_code": "735211234",
            "telephone_number": "580-379-6900",
            "fax_number": "580-379-6909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A",
        "authorized_official_last_name": "HARTGRAVES",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "580-379-5000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "OK",
            "license": "4040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson County Memorial Hospital Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jackson County Memorial Hospital Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Altus, OK

Sources for this page

Verify at the official NPI Registry.