Active NPI
Quitman Hospital LLC
- Rural Health Clinic/Center
- Quitman, TX
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rural Health Clinic/Center
- Legal business name
- QUITMAN HOSPITAL LLC
- Practice address
- 117 N Winnsboro St
Quitman, TX 75783-2144 - Phone
- (903) 763-6220
- Fax
- (903) 763-6221
- NPI assigned
- Feb 12, 2018
- Last updated
- Oct 1, 2023
- Organization subpart
- Yes
- Parent organization
- AHS EAST TEXAS HEALTH SYSTEM, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Stephen C. Petrovich
- Title
- Evp
- Phone
- (615) 296-3000
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | NU | Primary |
Addresses
Primary practice location
117 N Winnsboro St
Quitman, TX 75783-2144
Mailing address
340 Seven Springs Way Ste 100
Brentwood, TN 37027-5697
Phone (615) 296-3000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180522002100 | TX | Part A Provider - Rural Health Clinic | 9133484330 | Practice locations: Quitman, TX |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1306345764. Details of each certification follow.
Rural health clinic certification: CCN 458852
- Legal name
- QUITMAN HOSPITAL LLC
- Doing business as
- UT HEALTH EAST TEXAS QUITMAN HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 7, 2004
- Last certification
- Feb 27, 2018
- Ownership / control type
- 2B
- Most recent change of ownership
- Mar 1, 2018 (1 total)
- Organization structure
- LLC
- Incorporated
- Dec 19, 2017 in DE
- Enrollment address
- 117 N Winnsboro St
Quitman, TX 75783-2144 - Related CCNs
- 451380
Related certifications (CCN) 1
Facilities connected through Provider of Services related, parent or unit certification numbers.
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
- Quitman Hospital LLC
Other organizations with this tax ID 6
Organizations that report the same tax identification number in the National Provider Directory.
-
- Rural Health Clinic/Center
- Mineola, TX
- NPI 1205335726
-
- Internal Medicine Physician
- Quitman, TX
- NPI 1205336609
-
- Critical Access Hospital
- Quitman, TX
- NPI 1477061885
-
- Certified Registered Nurse Anesthetist
- Quitman, TX
- NPI 1629571773
-
- Rural Health Clinic/Center
- Winnsboro, TX
- NPI 1861109654
-
- Rural Health Clinic/Center
- Canton, TX
- NPI 1932608452
Ownership & related parties
All disclosed owners & managing parties 10
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Ardent Health Inc | 5% Or Greater Indirect Ownership Interest | Mar 1, 2018 | 100% |
| Ahs Texas, LLC | 5% Or Greater Indirect Ownership Interest | Jan 1, 2019 | |
| Martin Bonick | Corporate Officer | Aug 19, 2020 | |
| Mary a Crabtree | Corporate Officer | Mar 1, 2018 | |
| Ahs Management Company Inc. | Operational/Managerial Control | Mar 1, 2018 | |
| Stephen C Petrovich | Corporate Officer | Mar 1, 2018 | |
| Ardent Legacy Holdings LLC | 5% Or Greater Indirect Ownership Interest | Mar 1, 2018 | 100% |
| Ahs East Texas Health System, LLC | 5% Or Greater Direct Ownership Interest | Mar 1, 2018 | 100% |
| Donald Baker | Corporate Officer | Sep 1, 2021 | 100% |
| W-2 Managing Employee | Sep 1, 2021 | 100% | |
| Ahp Health Partners, Inc | 5% Or Greater Indirect Ownership Interest | Mar 1, 2018 | 100% |
Facilities with the same owner 61
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
- General Acute Care Hospital
- Athens, TX
- NPI 1417465824
Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC
-
- General Acute Care Hospital
- Amarillo, TX
- NPI 1407191984
Ahp Health Partners, Inc, Ahs Management Company Inc., Ardent Health Inc, Ardent Legacy Holdings LLC
-
- Rehabilitation Hospital Unit
- Amarillo, TX
- NPI 1730425190
Ahp Health Partners, Inc, Ahs Management Company Inc., Ardent Health Inc, Ardent Legacy Holdings LLC
-
- Rural Health Clinic/Center
- Carthage, TX
- NPI 1407355860
Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC
-
- General Acute Care Hospital
- Carthage, TX
- NPI 1538667035
Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC
-
- Rural Health Clinic/Center
- Carthage, TX
- NPI 1639678030
Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC
-
dba Rehabilitation Hospital of Amarillo
- Rehabilitation Hospital
- Amarillo, TX
- NPI 1487443099
Ahp Health Partners, Inc, Ardent Health Inc, Ardent Legacy Holdings LLC
-
- Rural Health Clinic/Center
- Chandler, TX
- NPI 1235706581
Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC
-
- Rural Health Clinic/Center
- Gun Barrel City, TX
- NPI 1689241945
Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC
-
dba BSA Hospice of the Southwest
- Community Based Hospice Care Agency
- Amarillo, TX
- NPI 1467447854
Ardent Legacy Holdings LLC
-
dba UTHealth East Texas Henderson Hospital
- General Acute Care Hospital
- Henderson, TX
- NPI 1326546797
Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC
-
- Rural Health Clinic/Center
- Henderson, TX
- NPI 1952800310
Ahp Health Partners, Inc, Ahs East Texas Health System, LLC, Ahs Management Company Inc., Ahs Texas, LLC, Ardent Health Inc, Ardent Legacy Holdings LLC
Change-of-ownership history 1
| Date | Event | Counterparty |
|---|---|---|
| Mar 1, 2018 | Change of Ownership | Etmc First Physicians Clinic Quitman |
Change of ownership 1
Medicare changes of ownership in which this facility was the buyer or the seller.
-
dba ETMC First Physicians Clinic Quitman
- Rural Health Clinic/Center
- Quitman, TX
- NPI 1508871245
Acquired from, 2018-03-01
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1518393600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1696118400000",
"number": "1306345764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "340 SEVEN SPRINGS WAY STE 100",
"city": "BRENTWOOD",
"state": "TN",
"postal_code": "370275697",
"telephone_number": "615-296-3000",
"fax_number": "615-296-6227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 N WINNSBORO ST",
"city": "QUITMAN",
"state": "TX",
"postal_code": "757832144",
"telephone_number": "903-763-6220",
"fax_number": "903-763-6221"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "QUITMAN HOSPITAL LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "AHS EAST TEXAS HEALTH SYSTEM, LLC",
"enumeration_date": "2018-02-12",
"last_updated": "2023-10-01",
"certification_date": "2023-10-01",
"status": "A",
"authorized_official_last_name": "PETROVICH",
"authorized_official_first_name": "STEPHEN",
"authorized_official_middle_name": "C.",
"authorized_official_title_or_position": "EVP",
"authorized_official_telephone_number": "615-296-3000"
},
"taxonomies": [
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Quitman, TX
- Haley Papez, M.ED.
- Kristina R Pearson, PT
- Quitman Health Services, PLLC (Quitman Chiropractic and Acupuncture)
- Quitman Hometown Dental
- Quitman Hospital LLC
- Quitman Hospital LLC
- Quitman Hospital LLC
- Quitman Isd
- Quitman Nursing and Rehab Center, LLC (Heritage Healthcare Residence)
- Quitman Therapy and Rehabilitation
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.