Sweeny Hospital District
Organization Active NPI Rural Health Clinic/Center · West Columbia, TX
NPI 1770081028 · NPPES record last updated Oct 10, 2024
Key facts
- NPI
- 1770081028
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- SWEENY HOSPITAL DISTRICT
- Practice address
- 411 W Brazos Ave
West Columbia, TX 77486-2611 - Phone
- (979) 345-2525
- NPI assigned
- Jan 31, 2018
- Organization subpart
- No
Authorized official
- Name
- Kelly Park
- Title
- Ceo
- Phone
- (979) 548-1582
Owners & managing parties with NPI records 11
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 9
Related certifications (CCN) 1
Practitioners 12
-
Haider Salam Alwash, M.D.
-
Felicia Nichole Chretien, FNP-BC
-
Eloiza Figueroa, FNP-C
-
Amy Lynn Keffer, MD
-
Mohammad Afzal Khan, M.D.
-
Laura M Pena, MSN, APRN, FNP-BC
-
Saleem Raslan, M.D.
-
Daniel A Shurtleff, PA-C
-
Chesney Sims Sisson, FNP
-
Andrea Nicole Todd, FNP-C
-
Larry Ladi, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Rural health clinic certification: CCN 673461
- Legal name
- SWEENY HOSPITAL DISTRICT
- Doing business as
- WEST COLUMBIA RURAL HEALTH CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jan 9, 2018
- Last certification
- Nov 11, 2025
- Ownership / control type
- Non-profit – church related
- Organization structure
- Government · Non-profit
- Enrollment address
- 411 W Brazos Ave
West Columbia, TX 77486-2611 - Related CCNs
- 451311
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Kelly R. Park |
Corporate Director | Aug 1, 2019 | |
| W-2 Managing Employee |
Aug 1, 2019 | ||
| Sweeny Hospital District |
Operational/Managerial Control | Jan 1, 1966 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20151106001237 | TX | Part a Provider - Rural Health Clinic | 3173435260 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: West Columbia, TX |
National Provider Directory
- Tax ID family
- Mendez Rodolfo
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | TX | Yes | |
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
411 W Brazos Ave
West Columbia, TX 77486-2611
Mailing address
305 N McKinney St
Sweeny, TX 77480-2801
Phone (979) 548-1598
Other names
- West Columbia Rural Health Clinic
Other providers in West Columbia, TX
- Robert L. Coburn, D.C.,P.C.
- Carolyn Schneider
- Paula Seiler
- Pauline Spencer
- Janet Ann Spicer III
- Tot Pharmacy
- Tot Pharmacy LLC
- Total Physical Therapy & Rehab
- Cydney Varner
- Wal-Mart Stores Texas LLC
All providers in West Columbia, 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 Oct 10, 2024. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.