NPIMap

Organization Active NPI

Access Medical Clinic LLC

  • Rural Health Clinic/Center
  • Palestine, TX
National Provider Identifier
1386479392
Registry record updated Feb 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ACCESS MEDICAL CLINIC LLC
Practice address
2223 S Loop 256
Palestine, TX 75801-4701
Phone
(430) 327-0070
Fax
(430) 327-0073
NPI assigned
Sep 9, 2024
Last updated
Feb 27, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2025

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

Authorized official

Name
Monya York
Title
Director Credentialing
Phone
(870) 856-1202

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

2223 S Loop 256
Palestine, TX 75801-4701

Mailing address

4196 Highway 62 412 Ste a
Hardy, AR 72542-8002

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20231013002943 TX Part B Supplier - Clinic/Group Practice 1951721802 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Big Spring, TX; Palestine, TX
O20241030000950 TX Part A Provider - Rural Health Clinic 1951721802 Practice locations: Palestine, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386479392. Details of each certification follow.

Rural health clinic certification: CCN 678937

Legal name
ACCESS MEDICAL CLINIC LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 9, 2025
Last certification
Jan 9, 2025
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Jun 12, 2020 in TN
Enrollment address
2223 S Loop 256
Palestine, TX 75801-4701

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Access Medical Clinic11 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 6

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

NameRoleSinceShare
Mark Hahn Individual 5% Or Greater Direct Ownership InterestDO May 8, 2025 100%
Corporate OfficerMedical Director May 8, 2025
Jared Clifford Individual Corporate OfficerPresident May 8, 2025
Sheri N Davis Individual W-2 Managing EmployeeVP of Provider Mgmnt May 8, 2025
Monya York Individual Corporate DirectorController Sep 22, 2022
W-2 Managing EmployeeController Sep 22, 2022
Operational/Managerial ControlController Sep 22, 2022
Randi L Davis Individual W-2 Managing EmployeeDirector Provider Mgmnt May 8, 2025
Candice M Cartwright Individual W-2 Managing EmployeeVP Operations May 8, 2025

Owners & managing parties with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1725840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740614400000",
    "number": "1386479392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4196 HIGHWAY 62 412 STE A",
            "city": "HARDY",
            "state": "AR",
            "postal_code": "725428002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2223 S LOOP 256",
            "city": "PALESTINE",
            "state": "TX",
            "postal_code": "758014701",
            "telephone_number": "430-327-0070",
            "fax_number": "430-327-0073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACCESS MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-09",
        "last_updated": "2025-02-27",
        "certification_date": "2025-02-27",
        "status": "A",
        "authorized_official_last_name": "YORK",
        "authorized_official_first_name": "MONYA",
        "authorized_official_title_or_position": "DIRECTOR CREDENTIALING",
        "authorized_official_telephone_number": "870-856-1202"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palestine, TX

Sources for this page

Verify at the official NPI Registry.