NPIMap

Organization Active NPI

Comanche County Medical Center Company

Doing business as Patrick Street Pharmacy

  • Community/Retail Pharmacy
  • Dublin, TX
National Provider Identifier
1760006076
Registry record updated Oct 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
COMANCHE COUNTY MEDICAL CENTER COMPANY
Doing business as
Patrick Street Pharmacy
Practice address
303 N Patrick St
Dublin, TX 76446-1918
Phone
(254) 445-4709
Fax
(254) 335-0990
NPI assigned
Jun 2, 2020
Last updated
Oct 16, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
COMANCHE COUNTY MEDICAL CENTER COMPANYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 16, 2020

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

Authorized official

Name
Jason Ray Cogburn
Title
It Manager
Phone
(254) 879-4900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

303 N Patrick St
Dublin, TX 76446-1918

Mailing address

303 N Patrick St
Dublin, TX 76446-1918
Phone (254) 445-4709

Other identifiers 2

IdentifierTypeStateIssuer
150252MedicaidTX
7824810002OtherTXPTAN

Other names 1

  • Patrick Street Pharmacy Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20191023000362 TX Part B Supplier - Pharmacy 3678753357 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Comanche, TX; Dublin, TX; Rising Star, TX
O20200930000289 TX DME Supplier - Pharmacy 4385552413 Practice locations: Dublin, TX

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 2

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Patrick Street Pharmacy303 N Patrick St, Dublin, TX 76446-1918(254) 445-4709 Nebulizer Drugs Accepts assignmentParticipating since Jan 1, 1995

National Provider Directory

National Provider Directory
Tax ID family
Comanche County Med Ctr7 organizations share this tax ID, including this one
Part of
Comanche County Med Ctr

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

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

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Comanche County Medical CenterComanche, TX, CCN 451382 Hospital 5% Or Greater Direct Ownership Interest Nov 1, 2011
Comanche County Medical Center CompanyRising Star, TX, CCN 678555 Rural health clinic Operational/Managerial Control Apr 1, 2021

Owned or controlled facilities with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1591056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602806400000",
    "number": "1760006076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 N PATRICK ST",
            "city": "DUBLIN",
            "state": "TX",
            "postal_code": "764461918",
            "telephone_number": "254-445-4709",
            "fax_number": "254-335-0990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 N PATRICK ST",
            "city": "DUBLIN",
            "state": "TX",
            "postal_code": "764461918",
            "telephone_number": "254-445-4709",
            "fax_number": "254-335-0990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMANCHE COUNTY MEDICAL CENTER COMPANY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMANCHE COUNTY MEDICAL CENTER COMPANY",
        "enumeration_date": "2020-06-02",
        "last_updated": "2020-10-16",
        "certification_date": "2020-10-16",
        "status": "A",
        "authorized_official_last_name": "COGBURN",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "IT MANAGER",
        "authorized_official_telephone_number": "254-879-4900"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150252",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "7824810002",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Patrick Street Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Patrick Street Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dublin, TX

Sources for this page

Verify at the official NPI Registry.