NPIMap

Organization Active NPI

Mitchell County Hospital District

Doing business as Family Medical Associates

  • Rural Health Clinic/Center
  • Colorado City, TX
National Provider Identifier
1518976836
Registry record updated Feb 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
75 Issued in TX
Legal business name
MITCHELL COUNTY HOSPITAL DISTRICT
Doing business as
Family Medical Associates
Practice address
997 W Interstate 20
Colorado City, TX 79512-2685
Phone
(325) 728-8522
Fax
(325) 728-2420
NPI assigned
Aug 5, 2006
Last updated
Feb 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2011

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

Authorized official

Name
Mr. Robert Murray Hall
Title
Office Manager
Phone
(325) 728-8522

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 75 TX Primary

Addresses

Primary practice location

997 W Interstate 20
Colorado City, TX 79512-2685

Mailing address

997 W Interstate 20
Colorado City, TX 79512-2685
Phone (325) 728-8522

Other identifiers 2

IdentifierTypeStateIssuer
00K83JOtherTXBLUE CROSS BLUE SHIELD
111482902MedicaidTX

Other names 1

  • Family Medical Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040510000697 TX Part A Provider - Rural Health Clinic 9739071176 Practice locations: Colorado City, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1518976836. Details of each certification follow.

Rural health clinic certification: CCN 453403

Legal name
MITCHELL COUNTY HOSPITAL DISTRICT
Doing business as
FAMILY MEDICAL ASSOCIATES
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 19, 1992
Last certification
Jan 12, 2016
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
997 W Interstate 20
Family Medical Associates
Colorado City, TX 79512-2685
Related CCNs
451342

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Sweetwater Family Medical Associates11 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.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Patricia G Pharis Individual Corporate DirectorBoard Member May 22, 2007
Henryk Olstowski Individual Corporate DirectorBoard Member Mar 22, 2022
Suzanne Michelle Gafford Individual Corporate DirectorChief Executive Officer Dec 1, 2022
W-2 Managing EmployeeChief Executive Officer Dec 1, 2022
Cheryl Warren Individual Corporate DirectorBoard Member Apr 30, 2013
Helen Edwards Individual Corporate DirectorBoard Member Nov 1, 2019
Robert Hall Individual Corporate DirectorChief Operating Officer Sep 1, 2022
W-2 Managing EmployeeChief Operating Officer Aug 1, 2022
Randall Anderson Individual Corporate DirectorBoard Member Apr 27, 2021
Marsha Rickard Individual Corporate DirectorBoard Member May 18, 2016
Maria Rubio Individual Corporate DirectorBoard Member Jul 24, 2018
Diane C Moore Individual Corporate DirectorChief Financial Officer Apr 24, 2023
W-2 Managing EmployeeChief Financial Officer Apr 24, 2023
Mitchell County Hospital District Organization, Colorado City, TX Operational/Managerial Control Jan 1, 1992 100%

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Mitchell County Hospital DistrictColorado City, TX, CCN 451342 Hospital Operational/Managerial Control Sep 1, 2010
Mitchell County Hospital DistrictColorado City, TX, CCN 45Z342 Hospital Operational/Managerial Control Sep 1, 2010
Mitchell County Nursing and Rehabilitation CenterColorado City, TX, CCN 676225 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Jan 1, 1967
Dec 30, 2024
Jan 14, 2025

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

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

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": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298246400000",
    "number": "1518976836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "997 W INTERSTATE 20",
            "city": "COLORADO CITY",
            "state": "TX",
            "postal_code": "795122685",
            "telephone_number": "325-728-8522",
            "fax_number": "325-728-2420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "997 W INTERSTATE 20",
            "city": "COLORADO CITY",
            "state": "TX",
            "postal_code": "795122685",
            "telephone_number": "325-728-8522",
            "fax_number": "325-728-2420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MITCHELL COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2011-02-21",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "MURRAY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "325-728-8522",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "TX",
            "license": "75",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "00K83J",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111482902",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado City, TX

Sources for this page

Verify at the official NPI Registry.