Piggott Community Hospital
Organization Active NPI Rural Health Clinic/Center · Rector, AR
NPI 1679564413 · NPPES record last updated Oct 26, 2023
Key facts
- NPI
- 1679564413
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- PIGGOTT COMMUNITY HOSPITAL
- Practice address
- 715 E 9TH St
Rector, AR 72461-2705 - Phone
- (870) 595-3596
- Fax
- (870) 595-3598
- NPI assigned
- Nov 1, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. James L Magee
- Title
- Executive Director
- Phone
- (870) 598-3881
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 12
Related certifications (CCN) 1
Facilities with the same owner 4
Practitioners 10
-
Ahmad Al-Hindi, MD
-
Dennis N Blake, M.D.
-
JT Dewitt Jr., D.O.
-
Larry Herbert Lawrence, M.D.
-
Paula Lyn Magee Simmons, APRN
-
Brittnay Mossman, CNP
-
Pamela D Lowe, APRN, ACNPC-AG
-
Randy G McComb, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 04D0897814 | Family Care Clinic of Rector | Provider-performed microscopy | Jan 23, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Rural health clinic certification: CCN 043448
- Legal name
- PIGGOTT COMMUNITY HOSPITAL
- Doing business as
- FAMILY CARE CLINIC OF RECTOR
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Sep 18, 1995
- Last certification
- Jan 3, 2019
- Ownership / control type
- 2B
- Most recent change of ownership
- Dec 12, 2000 (1 total)
- Organization structure
- Other · Proprietary
- Enrollment address
- 715 E 9TH St
Rector, AR 72461-2705 - Related CCNs
- 041330
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Barry Dehart |
5% Or Greater Direct Ownership Interest |
Aug 13, 2020 | 10% |
| Corporate Director |
Aug 13, 2020 | ||
| Brad Scheffler |
5% Or Greater Direct Ownership Interest |
Jan 1, 2023 | 5% |
| Corporate Director |
Jan 1, 2023 | ||
| Cody Knight |
5% Or Greater Direct Ownership Interest |
Jan 14, 2020 | 10% |
| Corporate Director |
Jan 14, 2020 | ||
| James L Magee |
W-2 Managing Employee |
Nov 1, 1997 | 50% |
| Stephanie Lowe |
5% Or Greater Direct Ownership Interest |
Jun 30, 2021 | 5% |
| Corporate Director |
Jun 30, 2021 | ||
| City of Piggott |
5% Or Greater Direct Ownership Interest | Dec 21, 2000 | 100% |
| David Gregory |
5% Or Greater Direct Ownership Interest |
Mar 29, 2018 | 10% |
| Corporate Director |
Mar 29, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080429000908 | AR | Part a Provider - Rural Health Clinic | 0345140448 | Practice locations: Rector, AR |
National Provider Directory
- Tax ID family
- Campbell Medical Clinic
Locations
715 E 9th St
Rector, AR 72461
Phone (870) 595-3596
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | AR | Yes |
Addresses
Primary practice location
715 E 9TH St
Rector, AR 72461-2705
Mailing address
715 E 9TH St
Rector, AR 72461-2705
Phone (870) 595-3596
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 146636729 | Medicaid | AR | |
| 595941501 | Medicaid | MO |
Other names
- FAMILY CARE CLINIC OF RECTOR
Other providers in Rector, AR
- Jeffrey Louis Hummert
- Shelley Renee Lockhart
- Mary Ann Lovrien
- Amy Manchester
- Piggott Community Hospital
- Rector Downtown Drug, Inc.
- Rector Downtown Drug, Inc.
- Rector Downtown Drug, Inc.
- Rector Downtown Drug, Inc.
- Rector Nursing & Rehab Center, Inc.
All providers in Rector, AR · Rural Health Clinic/Center in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2023. 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.