Preferred Hospital Leasing Junction, Inc
Organization Active NPI Rural Health Clinic/Center · Junction, TX
NPI 1578729653 · NPPES record last updated Jul 12, 2022
Key facts
- NPI
- 1578729653
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- PREFERRED HOSPITAL LEASING JUNCTION, INC
- Practice address
- 399 Reid Rd
Junction, TX 76849-3049 - Phone
- (325) 446-3321
- Fax
- (325) 446-3769
- NPI assigned
- Jul 29, 2008
- Organization subpart
- No
Authorized official
- Name
- Donald A Freeman
- Title
- President
- Phone
- (405) 878-0202
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 3
Related certifications (CCN) 1
Facilities with the same owner 35
Practitioners 30
-
Payden Morgan Land, MPAS, PA-C
-
Clinton W. Ray, P.A.
-
Amanda Sattler, PA-C
-
Gregory Sattler, MD
-
Jay Jackson, MD
-
Michael Wayne Eaton Jr., F.N.P
-
Brandon Christian Stroh, M.D.
-
Douglas L Best, MD
-
Tamara Carroll, M.D.
-
Mark Lewis Epstein, M.D.
-
Gautham Reddy Kandukuri, M.D.
-
Hassan Massouh, M.D.
-
Jonathan Samuel McDougal, M.D.
-
Matthew James Sigley, D.O.
-
Moayad Tarboush, M.D.
-
Matthew E Williamson, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D0886273 | Junction Medical Clinic | Certificate of waiver | May 10, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX
Rural health clinic certification: CCN 458531
- Legal name
- PREFERRED HOSPITAL LEASING JUNCTION, INC
- Doing business as
- JUNCTION MEDICAL CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jun 22, 1994
- Last certification
- May 27, 2015
- Ownership / control type
- 1B
- Organization structure
- Corporation · Proprietary
- Incorporated
- Apr 1, 2008 in OK
- Enrollment address
- 399 Reid Rd
Junction Medical Clinic
Junction, TX 76849-3049 - Related CCNs
- 451306
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Donald a Freeman |
5% Or Greater Direct Ownership Interest | Jun 1, 2008 | |
| Corporate Director | Jun 1, 2008 | ||
| Preferred Management Corporation |
Operational/Managerial Control | Jun 1, 2008 | |
| Duke Young |
W-2 Managing Employee |
Sep 1, 2018 | |
| Karla a Betterton |
Corporate Director | Jun 1, 2008 | |
| Jared Chanski |
Corporate Officer |
Jan 1, 2019 | |
| Josh Tucker |
Corporate Officer |
Jan 1, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081017000365 | TX | Part a Provider - Rural Health Clinic | 4981762051 | Practice locations: Junction, TX |
| O20091113000439 | TX | Part B Supplier - Clinic/Group Practice | 4981762051 |
Receives reassigned benefits from 30 practitioners 1 other NPI on this enrollment Practice locations: Junction, TX; Rocksprings, TX |
National Provider Directory
Locations
212 E Main St
Rocksprings, TX 78880
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | |||
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
399 Reid Rd
Junction, TX 76849-3049
Mailing address
120 W Macarthur St
Suite 121
Shawnee, OK 74804-2007
Phone (405) 878-0202
Other names
- Junction Medical Clinic
Other providers in Junction, TX
- Penny L. Montieth
- Adriana Munoz
- Orthopedic Solutions
- Cordelia Osato Osidele
- Preferred Hospital Leasing Junction, Inc
- Preferred Hospital Leasing Junction, Inc
- Preferred Hospital Leasing Junction, Inc
- Amanda Sattler
- Gregory Sattler
- Connie M Seibel
All providers in Junction, TX · Rural Health Clinic/Center in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 12, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.