Liberty County Hospital District No 1

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

LIBERTY COUNTY HOSPITAL DISTRICT NO 1

Doing business as

Liberty Dayton Medical Specialty Clinic

Practice address

1202 N Travis St
Liberty, TX 77575-3540

Phone

(281) 915-0749

NPI assigned

Mar 4, 2024

Last updated

Mar 6, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Rhonda Campbell

Title

Chief Executive Officer

Phone

(936) 336-7316

Specialties & licenses 1

Addresses

Other names 1

• LIBERTY DAYTON MEDICAL SPECIALTY CLINIC Doing business as

Medicare fee-for-service enrollment

Enrolled in TX2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386401560. Details of each certification follow.

• CCN 678577 Rural health clinic · Active · Details

Rural health clinic certification: CCN 678577

Legal name

LIBERTY COUNTY HOSPITAL DISTRICT NO 1

Doing business as

LIBERTY DAYTON MEDICAL SPECIALTY CLINIC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Aug 21, 2025

Last certification

Aug 21, 2025

Ownership / control type

Non-profit – church related

Organization structure

OtherNon-profit

Enrollment address

1202 N Travis St
Liberty, TX 77575-3540

Related CCNs

451375

Related certifications (CCN) 1

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

• Liberty County Hospital District No 1

  dba Liberty Dayton Regional Medical Center

  • Critical Access Hospital
  • Liberty, TX
  • NPI 1154324952

  Parent provider

  Provider of Services

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Liberty County Hospital District No 1

  dba LDRMC Profession Services

  • Family Medicine Physician
  • Liberty, TX
  • NPI 1528367356

  O20160919002678

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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.

All facility ownership & control disclosures 38

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

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Amanuel Abreha, M.D.

  • Internal Medicine Physician
  • Liberty, TX
  • NPI 1821059841
  NPD
• Patrick James Asay, MD

  • Emergency Medicine Physician
  • El Paso, TX
  • NPI 1932724630
  NPD
• Joseph E T Bales, M.D.

  • Emergency Medicine Physician
  • College Station, TX
  • NPI 1700142387
  NPD
• Mark Ryan Boyle, MD

  • Emergency Medicine Physician
  • College Station, TX
  • NPI 1861519274
  NPD
• Stace Breland, DO

  • Emergency Medicine Physician
  • Aubrey, TX
  • NPI 1821417155
  NPD
• Kathe Anne Britt, RN

  • Family Nurse Practitioner
  • Dayton, TX
  • NPI 1285368274
  NPD
• Dale Wayne Brock, APN

  • Nurse Practitioner
  • Winnie, TX
  • NPI 1922055292
  NPD
• Meredith Gault Brown, M.D.

  • Emergency Medicine Physician
  • Katy, TX
  • NPI 1639306574
  NPD
• Brett Allen Burnett, M.D.

  • Emergency Medicine Physician
  • Temple, TX
  • NPI 1871813402
  NPD
• David Chiao, MD

  • Vascular & Interventional Radiology Physician
  • Bay City, TX
  • NPI 1336431352
  NPD
• Lindsay Fowler Dragos, M.D.

  • Emergency Medicine Physician
  • Houston, TX
  • NPI 1164713772
  NPD
• Stephanie Dunlop, M.D.

  • Emergency Medicine Physician
  • Waco, TX
  • NPI 1760865018
  NPD

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

{
    "created_epoch": "1709510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709683200000",
    "number": "1386401560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1353 N TRAVIS ST",
            "city": "LIBERTY",
            "state": "TX",
            "postal_code": "775753549",
            "telephone_number": "936-336-7316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 N TRAVIS ST",
            "city": "LIBERTY",
            "state": "TX",
            "postal_code": "775753540",
            "telephone_number": "281-915-0749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY COUNTY HOSPITAL DISTRICT NO 1",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-04",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "936-336-7316"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIBERTY DAYTON MEDICAL SPECIALTY CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LIBERTY DAYTON MEDICAL SPECIALTY CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Danny Kyaw Khine, MD
• Carissa Kathryn Kruckemeyer, PHARMD
• Jennifer Landaverde
• Liberty County Co-Op
• Liberty County Hospital District No 1 (Liberty Dayton Regional Medical Center)
• Liberty County Hospital District No 1 (LDRMC Profession Services)
• Liberty County Hospital District No 1 (Liberty Dayton Medical Clinic)
• Liberty County Hospital District No. 1 (The Heights of Tomball)
• Liberty County Hospital District No. 1
• Liberty Dayton Community Hospital

• Rural Health Clinic/Center in Liberty, TX
• Providers in Liberty, TX by specialty
• Rural Health Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.