NPIMap

Organization Active NPI

Memorial Hospital of Polk County

  • Rural Acute Care Hospital
  • Livingston, TX
National Provider Identifier
1689650616
Registry record updated Apr 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Acute Care HospitalTaxonomy code 282NR1301X
Legal business name
MEMORIAL HOSPITAL OF POLK COUNTY
Practice address
1717 Highway 59 Bypass
Livingston, TX 77351
Phone
(936) 327-4381
Fax
(936) 327-8702
NPI assigned
Dec 21, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2024

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

Authorized official

Name
Megan Glass
Title
Reimbursement Analyst
Phone
(936) 639-7661

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 000466 TX
General Acute Care Hospital 282N00000X
Rural Acute Care Hospital 282NR1301X Primary

Addresses

Primary practice location

1717 Highway 59 Bypass
Livingston, TX 77351

Mailing address

PO Box 1257
Memoiral Medical Center Livingston
Livingston, TX 77351-0022
Phone (936) 327-4381

Other identifiers 1

IdentifierTypeStateIssuer
112697102MedicaidTX

Other names 2

  • CHI St. Luke's Heath Memorial Livingston Doing business as
  • Memorial Health Center Livingston Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040503001283 TX Part A Provider - Hospital 1951399526 Practice locations: Livingston, TX

Hospital certification: CCN 450395

Legal name
MEMORIAL HOSPITAL OF POLK COUNTY
Doing business as
CHI ST LUKES HEALTH - MEMORIAL LIVINGSTON
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1974
Last certification
Apr 28, 2022
Beds
66
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
May 16, 1994 in TX
Enrollment address
1717 Highway 59 Bypass
Livingston, TX 77351-1717
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

Care Compare: Hospital

Medicare Care Compare
Listed as
CHI St Lukes Health Memorial LivingstonCCN 450395
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

300 Bypass Ln
Ste 208
Livingston, TX 77352
Phone (936) 327-1020

602 E Church St
Livingston, TX 77351
Phone (409) 327-4381

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Gary Whitlock Individual Corporate Director Jun 30, 2021
St. Lukes Health System Corporation Organization, Houston, TX Corporation 5% Or Greater Indirect Ownership Interest Jun 12, 2019
Commonspirit Health Organization, Chicago, IL Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jun 1, 2014 100%
Robert Upchurch Individual Corporate Officer Jun 30, 2021
Matthew Brown Individual Corporate OfficerPresident Jul 1, 2025
Corporate DirectorBoard Member Jul 1, 2025
Frank Ashley Individual Corporate Director Jun 30, 2021
Terika Richardson Mbanu Individual Corporate OfficerPresident, Commonspirit Health Jan 5, 2024
Corporate DirectorBoard Member Jul 1, 2025
Donald D Hearne Individual Corporate OfficerSecretary Jul 1, 2025
Brooks Bass Individual Corporate Director Jun 30, 2021
Brad Beers Individual Corporate Director Jun 30, 2021
Thomas Kopfensteiner Individual Corporate DirectorBoard Member Jul 1, 2025
Shelli D Brooks Individual Corporate Officer Jul 12, 2019
James Brad White Individual Corporate Director Jun 30, 2021
Jane Ainsworth Individual Corporate DirectorVP Jun 30, 2021
Monte J Bostwick Individual Corporate OfficerChief Operating Officer Aug 8, 2016
W-2 Managing EmployeeCeo Aug 8, 2016
Indira S Anupindi Individual Corporate Director Jun 30, 2021
Demetress L Harrell Individual Corporate Director Jun 30, 2021
St Lukes Health Clinical Operations Organization, Houston, TX Corporation 5% Or Greater Direct Ownership Interest Jun 30, 2021

Owners & managing parties with NPI records 1

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

Facilities with the same owner 18

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

View all 18

Practitioners & affiliated clinicians

Practitioners 63

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 63

Affiliated clinicians 170

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

View all 170

NPI Registry JSON

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711929600000",
    "number": "1689650616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1257",
            "address_2": "MEMOIRAL MEDICAL CENTER LIVINGSTON",
            "city": "LIVINGSTON",
            "state": "TX",
            "postal_code": "773510022",
            "telephone_number": "936-327-4381",
            "fax_number": "936-327-8702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 HIGHWAY 59 BYPASS",
            "city": "LIVINGSTON",
            "state": "TX",
            "postal_code": "77351",
            "telephone_number": "936-327-4381",
            "fax_number": "936-327-8702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL OF POLK COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-21",
        "last_updated": "2024-04-01",
        "certification_date": "2024-04-01",
        "status": "A",
        "authorized_official_last_name": "GLASS",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_title_or_position": "REIMBURSEMENT ANALYST",
        "authorized_official_telephone_number": "936-639-7661"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": "000466",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112697102",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHI St. Luke's Heath Memorial Livingston",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Memorial Health Center Livingston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Livingston, TX

Sources for this page

Verify at the official NPI Registry.