NPIMap

Organization Active NPI

Firm Foundations Healthcare Clinic PC

  • Rural Health Clinic/Center
  • Liberty, TX
National Provider Identifier
1437991973
Registry record updated Jun 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FIRM FOUNDATIONS HEALTHCARE CLINIC PC
Practice address
2708 Jefferson Dr
Ste a
Liberty, TX 77575-1036
Phone
(936) 334-8800
Fax
(936) 334-8801
NPI assigned
Jun 6, 2024
Last updated
Jun 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2024

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

Authorized official

Name
Stephanie Janel Smith, RT(R)
Title
Clinic Administrator
Phone
(936) 334-8800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

2708 Jefferson Dr
Ste a
Liberty, TX 77575-1036

Mailing address

2708 Jefferson Dr
Ste a
Liberty, TX 77575-1036
Phone (936) 334-8800

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240808002251 TX Part A Provider - Rural Health Clinic 1052475217 Practice locations: Liberty, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437991973. Details of each certification follow.

Rural health clinic certification: CCN 678939

Legal name
FIRM FOUNDATIONS HEALTHCARE CLINIC PC
Doing business as
FIRM FOUNDATIONS HEALTHCARE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 24, 2025
Last certification
Feb 24, 2025
Ownership / control type
1B
Organization structure
OtherProprietary
Incorporated
Oct 20, 2008 in TX
Enrollment address
2708 Jefferson Dr
Ste a
Liberty, TX 77575-1036

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Locations

1201 N Travis St
Liberty, TX 77575
Phone (936) 334-8800

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Stephanie Janel Smith Individual Operational/Managerial ControlAuthorized Official Dec 31, 2008
Brandon K Smith Individual 5% Or Greater Direct Ownership InterestPresident Apr 1, 2015 95%
W-2 Managing Employee Dec 31, 2008
Raymond J Luna Individual 5% Or Greater Direct Ownership Interest Apr 1, 2015

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 5

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": "1717632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717632000000",
    "number": "1437991973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2708 JEFFERSON DR",
            "address_2": "STE A",
            "city": "LIBERTY",
            "state": "TX",
            "postal_code": "775751036",
            "telephone_number": "936-334-8800",
            "fax_number": "936-334-8801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2708 JEFFERSON DR",
            "address_2": "STE A",
            "city": "LIBERTY",
            "state": "TX",
            "postal_code": "775751036",
            "telephone_number": "936-334-8800",
            "fax_number": "936-334-8801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRM FOUNDATIONS HEALTHCARE CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-06",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "JANEL",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "936-334-8800",
        "authorized_official_credential": "RT(R)"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Liberty, TX

Sources for this page

Verify at the official NPI Registry.