NPIMap

Organization Active NPI

El Campo Memorial Hospital

Doing business as Mid Coast Medical Center

  • Rural Health Clinic/Center
  • Wharton, TX
National Provider Identifier
1518465616
Registry record updated Dec 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
EL CAMPO MEMORIAL HOSPITAL
Doing business as
Mid Coast Medical Center
Practice address
1403 Valhalla Dr
Wharton, TX 77488-9218
Phone
(979) 532-2000
NPI assigned
Jan 24, 2018
Last updated
Dec 13, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
EL CAMPO MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 13, 2024

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

Authorized official

Name
Brett Kirkham
Title
Ceo
Phone
(979) 543-6251

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1403 Valhalla Dr
Wharton, TX 77488-9218

Mailing address

305 Sandy Corner Rd
El Campo, TX 77437-9535
Phone (979) 543-5510

Other names 1

  • Mid Coast Medical Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140813001385 TX Part B Supplier - Clinic/Group Practice 6406021765 Receives reassigned benefits from 38 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wharton, TX; Palacios, TX; Mason, TX; Louise, TX; Ganado, TX; El Campo, TX; Boling, TX; Blessing, TX…
O20180912001908 TX Part A Provider - Rural Health Clinic 6406021765 Practice locations: Wharton, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1518465616. Details of each certification follow.

Rural health clinic certification: CCN 673466

Legal name
EL CAMPO MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 16, 2018
Last certification
Jun 13, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 2011 in TX
Enrollment address
1403 Valhalla Dr
Wharton, TX 77488-9218
Related CCNs
450694

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 23

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

View all 23

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
45D1091772El Campo Memorial Hospital RHC1403 Valhalla Drive, Wharton, TX 77488Certificate of waiverNov 9, 2026

National Provider Directory

National Provider Directory
Tax ID family
El Campo Memorial Hospital27 organizations share this tax ID, including this one
Part of
El Campo Memorial Hospital

Other organizations with this tax ID 26

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

View all 26

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
David Mak Individual Corporate DirectorChief Financial Officer Jan 1, 2020
W-2 Managing EmployeeChief Financial Officer Jan 1, 2020
El Campo Memorial Hospital Organization, El Campo, TX Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 25, 2018 100%
Operational/Managerial Control Jan 25, 2018 100%
Brett Kirkham Individual Corporate DirectorActing Chief Executive Officer Oct 1, 2023
W-2 Managing EmployeeActing Chief Executive Officer Oct 1, 2023

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
El Campo Memorial HospitalEl Campo, TX, CCN 450694 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Apr 11, 2014
Apr 11, 2014
El Campo Memorial HospitalEl Campo, TX, CCN 45U694 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Apr 11, 2014
Apr 11, 2014
Mid Coast Medical ClinicEl Campo, TX, CCN 453463 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Apr 11, 2014
Apr 11, 2014
Mid Coast Well CareEl Campo, TX, CCN 673478 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 3, 2019
Jun 3, 2019

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1516752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734048000000",
    "number": "1518465616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 SANDY CORNER RD",
            "city": "EL CAMPO",
            "state": "TX",
            "postal_code": "774379535",
            "telephone_number": "979-543-5510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1403 VALHALLA DR",
            "city": "WHARTON",
            "state": "TX",
            "postal_code": "774889218",
            "telephone_number": "979-532-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL CAMPO MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EL CAMPO MEMORIAL HOSPITAL",
        "enumeration_date": "2018-01-24",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A",
        "authorized_official_last_name": "KIRKHAM",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "979-543-6251"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mid Coast Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wharton, TX

Sources for this page

Verify at the official NPI Registry.