NPIMap

Organization Active NPI

County of Clay

Doing business as Clay County Memorial Hospital

  • Surgery Physician
  • Henrietta, TX
National Provider Identifier
1639340748
Registry record updated Apr 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
COUNTY OF CLAY
Doing business as
Clay County Memorial Hospital
Practice address
310 W South St
Henrietta, TX 76365-3346
Phone
(940) 235-1202
Fax
(940) 235-1215
NPI assigned
Mar 17, 2008
Last updated
Apr 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2026

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

Authorized official

Name
Bob Steven Ellzey
Title
Interim Ceo
Phone
(940) 235-1200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X Primary
Pain Medicine Physician 208VP0000X

Addresses

Primary practice location

310 W South St
Henrietta, TX 76365-3346

Mailing address

310 W South St
Henrietta, TX 76365-3346
Phone (940) 235-1202

Other identifiers 2

IdentifierTypeStateIssuer
094138701MedicaidTX
094138703MedicaidTX

Other names 1

  • Clay County Memorial Hospital Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040701001413 TX Part B Supplier - Clinic/Group Practice 4981689783 Receives reassigned benefits from 10 practitioners
2 other NPIs on this enrollment
Practice locations: Henrietta, TX
O20061104000371 TX Part A Provider - Critical Access Hospital 4981689783 Receives reassigned benefits from 6 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Henrietta, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639340748. Details of each certification follow.

Hospital certification: CCN 451362

Legal name
COUNTY OF CLAY
Doing business as
CLAY COUNTY MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Mar 1, 2005
Last certification
Aug 18, 2021
Beds
25
Ownership / control type
Local
Organization structure
GovernmentNon-profit
Enrollment address
310 W South St
Clay County Memorial Hospital
Henrietta, TX 76365-3346

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 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Clay County Memorial HospitalCCN 451362 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

412 W South St
Henrietta, TX 76365
Phone (940) 235-3403

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Linda Burleson Individual W-2 Managing Employee Oct 28, 2009
County of Clay Organization, Henrietta, TX 5% Or Greater Direct Ownership Interest Oct 28, 2009
Bob Ellzey Individual Corporate DirectorInterim Ceo Jun 1, 2023
James E Koulovatos Individual W-2 Managing EmployeeCeo Dec 4, 2023 100%
Debra Haehn Individual Corporate DirectorCfo Oct 28, 2009
W-2 Managing EmployeeCfo Oct 28, 2009

Owners & managing parties with NPI records 4

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

  • County of Clay

    dba Clay County Memorial Hospital

    • Ambulance
    • Henrietta, TX
    • NPI 1093832784

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • County of Clay

    dba Clay County Memorial Hospital

    • Critical Access Hospital
    • Henrietta, TX
    • NPI 1437156361

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • County of Clay

    dba Clay County Memorial Hospital

    • Medicare Defined Swing Bed Hospital Unit
    • Henrietta, TX
    • NPI 1518023993

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • County of Clay

    dba Clay County Home Health Care

    • Home Health Agency
    • Henrietta, TX
    • NPI 1801803267

    5% Or Greater Direct Ownership Interest

    CMS ownership

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Clay County Memorial HospitalHenrietta, TX, CCN 451362 Hospital 5% Or Greater Direct Ownership Interest Oct 28, 2009
Clay County Memorial HospitalHenrietta, TX, CCN 45Z362 Hospital 5% Or Greater Direct Ownership Interest Oct 28, 2009
Clay County Home Health CareHenrietta, TX, CCN 677277 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Other (100%)		 Jan 1, 2002
Jan 1, 2002
Jan 1, 2002

Owned or controlled facilities with NPI records 4

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

  • County of Clay

    dba Clay County Memorial Hospital

    • Critical Access Hospital
    • Henrietta, TX
    • NPI 1437156361

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • County of Clay

    dba Clay County Memorial Hospital

    • Medicare Defined Swing Bed Hospital Unit
    • Henrietta, TX
    • NPI 1518023993

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • County of Clay

    dba Clay County Home Health Care

    • Home Health Agency
    • Henrietta, TX
    • NPI 1801803267

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control, Other

    CMS ownership
  • County of Clay

    dba Clay County Memorial Hospital

    • Critical Access Hospital Clinic/Center
    • Henrietta, TX
    • NPI 1881175776

    5% Or Greater Direct Ownership Interest

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 10

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.

Affiliated clinicians 45

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1205712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776038400000",
    "number": "1639340748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 W SOUTH ST",
            "city": "HENRIETTA",
            "state": "TX",
            "postal_code": "763653346",
            "telephone_number": "940-235-1202",
            "fax_number": "940-235-1215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W SOUTH ST",
            "city": "HENRIETTA",
            "state": "TX",
            "postal_code": "763653346",
            "telephone_number": "940-235-1202",
            "fax_number": "940-235-1215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF CLAY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-17",
        "last_updated": "2026-04-13",
        "certification_date": "2026-04-13",
        "status": "A",
        "authorized_official_last_name": "ELLZEY",
        "authorized_official_first_name": "BOB",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "INTERIM CEO",
        "authorized_official_telephone_number": "940-235-1200"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "094138701",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "094138703",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clay County Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henrietta, TX

Sources for this page

Verify at the official NPI Registry.