Organization Active NPI

Carthage Hospital, LLC

  • Rural Health Clinic/Center
  • Carthage, TX
National Provider Identifier
1407355860
Registry record updated Oct 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CARTHAGE HOSPITAL, LLC
Practice address
305 Cottage Rd
Carthage, TX 75633-1511
Phone
(903) 694-4948
Fax
(903) 694-4671
NPI assigned
Feb 12, 2018
Last updated
Oct 1, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
AHS EAST TEXAS HEALTH SYSTEM, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 1, 2023

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)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

305 Cottage Rd
Carthage, TX 75633-1511

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 IDStateProvider typePAC IDDetails
O20180424002477 TX Part A Provider - Rural Health Clinic 0648532077 Practice locations: Carthage, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407355860. Details of each certification follow.

Rural health clinic certification: CCN 673408

Legal name
CARTHAGE HOSPITAL, LLC
Doing business as
UT HEALTH EAST TEXAS CARTHAGE PHYSICIAN CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 17, 2013
Last certification
Oct 19, 2015
Ownership / control type
2B
Most recent change of ownership
Mar 1, 2018 (1 total)
Organization structure
LLCProprietary
Incorporated
Dec 19, 2017 in DE
Enrollment address
305 Cottage Rd
Carthage, TX 75633-1511
Related CCNs
450210

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

Other NPIs with the same Medicare PAC ID 2

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2050705Carthage Hospital, LLC305 Cottage Road, Carthage, TX 75633Certificate of waiverDec 4, 2026

National Provider Directory

National Provider Directory
Tax ID family
Carthage Hospital LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

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.

NameRoleSinceShare
Ardent Health Inc Organization, Brentwood, TN LLC 5% Or Greater Indirect Ownership Interest Mar 1, 2018 100%
Ahs Texas, LLC Organization, Brentwood, TN LLC 5% Or Greater Indirect Ownership Interest Jan 1, 2019 100%
Martin Bonick Individual Corporate OfficerCeo-Chain Office Aug 19, 2020
Mary a Crabtree Individual Corporate OfficerSVP Treasurer Mar 1, 2018
Ahs Management Company Inc. Organization, Brentwood, TN Corporation Operational/Managerial Control Mar 1, 2018
Stephen C Petrovich Individual Corporate Officer Mar 1, 2018
Ardent Legacy Holdings LLC Organization, Brentwood, TN LLC 5% Or Greater Indirect Ownership Interest Mar 1, 2018 100%
Ahs East Texas Health System, LLC Organization, Brentwood, TN LLC 5% Or Greater Direct Ownership Interest Mar 1, 2018 100%
Donald Baker Individual Corporate OfficerCfo Nov 1, 2020 100%
W-2 Managing EmployeeCfo Nov 1, 2020 100%
Ahp Health Partners, Inc Organization, Brentwood, TN Corporation 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.

View all 61

Change-of-ownership history 1

DateEventCounterparty
Mar 1, 2018 Change of OwnershipThis provider was the buyer Etmc First Physicians Clinic Center IIICCN 673408, TX, NPI 1629314539

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

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": "1407355860",
    "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": "305 COTTAGE RD",
            "city": "CARTHAGE",
            "state": "TX",
            "postal_code": "756331511",
            "telephone_number": "903-694-4948",
            "fax_number": "903-694-4671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARTHAGE 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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carthage, TX

Sources for this page

Verify at the official NPI Registry.