Jack County Hospital District
Organization Active NPI General Acute Care Hospital · Jacksboro, TX
NPI 1790777696 · NPPES record last updated Sep 16, 2021
Key facts
- NPI
- 1790777696
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 100322 (TX)
- Legal business name
- JACK COUNTY HOSPITAL DISTRICT
- Practice address
- 215 Chisholm TRL
Jacksboro, TX 76458 - Phone
- (940) 567-6633
- Fax
- (940) 567-2895
- NPI assigned
- Aug 17, 2005
- Organization subpart
- No
Authorized official
- Name
- Mrs. Kim Lee
- Title
- Coo
- Phone
- (940) 567-6633
Owners & managing parties with NPI records 1
Owned or controlled facilities with NPI records 9
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 1
Member of 1
Related certifications (CCN) 6
Facilities with the same owner 8
Practitioners 44
-
Jennifer Archer, DO
-
Ariel Ann-Ski Carter, APRN, FNP-C
-
Jessica Coker, APRN, FNP
-
Joshua Mark Evans, D.O.
-
Cathy Gresham, FNP-BC
-
Jeremy Wayne Johnson, D.O.
-
Dara Nicole Lankford, APRN
-
Delbert L McCaig, DO
-
Joseph Peter Mozur III, C.R.N.A.
-
John Ryan Nuckols, DNP CRNA
-
Aaron Garrett Purdy, M.D.
-
Cynthia L Robertson, RN,FNP-C
-
Katie Rae Shaw, FNP-C
-
Shawn L White, MD
-
Shivum Agarwal, M.D.
-
Brandy Baker, RN
-
Amy Danielle Cosgrove, M.D.
Affiliated clinicians 74
-
Shivum Agarwal, M.D.
-
Joseph Agnew, M.D.
-
Jennifer Archer, DO
-
Jack Charles Askins, M. D.
-
Meria G Aulds, MD
-
Iftikhar Burney, MD
-
Ariel Ann-Ski Carter, APRN, FNP-C
-
Jessica Coker, APRN, FNP
-
John Colbath, DO
-
Amy Danielle Cosgrove, M.D.
-
Saritha Dodla, M.D.
-
Claressa Donley, FNP
-
Katherine Dowd, MD
-
Joshua Mark Evans, D.O.
-
Jessa C Foster, FNP
-
Cathy Gresham, FNP-BC
-
Michael A Hames, M.D.
-
Syed N Hussain, MBBS
Medicare Care Compare: Hospital
- Listed as
- Faith Community Hospital
- Type
- Acute Care Hospitals
- Ownership
- Government - Hospital District or Authority
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in TX
Hospital certification: CCN 450241
- Legal name
- JACK COUNTY HOSPITAL DISTRICT
- Doing business as
- FAITH COMMUNITY HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Apr 20, 2022
- Beds
- 41
- Ownership / control type
- Hospital district or authority
- Organization structure
- Government · Non-profit
- Enrollment address
- 215 Chisholm Trail
Jacksboro, TX 76458-1403 - Hospital subgroups
- General, Acute care
Hospital certification: CCN 45U241
- Legal name
- JACK COUNTY HOSPITAL DISTRICT
- Organization structure
- Government · Non-profit
- Enrollment address
- 215 Chisholm Trail
Jacksboro, TX 76458-1403 - Hospital subgroups
- Swing-bed approved
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| James Hammond |
Corporate Director |
Jan 1, 2015 | |
| Mark Maples |
Corporate Director | Aug 25, 2010 | |
| Lori McBrayer |
Corporate Director |
Jan 1, 2015 | |
| Leslie Chalmers |
Corporate Director |
Jan 1, 2020 | |
| Corporate Director |
Jan 1, 2020 | ||
| Larry Hopwood |
Corporate Director |
Jan 1, 2015 | |
| Jack County Hospital District |
Operational/Managerial Control | Aug 25, 2010 | |
| Kim Lee |
Corporate Director |
Oct 1, 2024 | |
| W-2 Managing Employee |
Sep 1, 2015 | ||
| Frank L Beaman |
Corporate Director |
Sep 27, 2012 | |
| W-2 Managing Employee | Jan 20, 2011 | ||
| W-2 Managing Employee |
Jan 20, 2011 | ||
| Trina D Johnson |
W-2 Managing Employee |
Oct 1, 2024 |
All facility ownership & control disclosures 8
| Facility | Type | Role | Since |
|---|---|---|---|
| Jack County Hospital District |
Hospital | Operational/Managerial Control | Aug 25, 2010 |
| Avir at Jacksboro |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Sep 30, 2014 |
| Park View Care Center |
Skilled nursing facility | 5% Or Greater Indirect Ownership Interest | Oct 1, 2014 |
| Arlington Residence and Rehabilitation Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Sep 30, 2013 |
| Jack County Medical Clinic |
Rural health clinic | Operational/Managerial Control | Jun 1, 2010 |
| FCH Rural Health Clinic Bowie |
Rural health clinic | Operational/Managerial Control | May 1, 2017 |
| FCH Rural Health Clinic Alvord |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Nov 1, 2018 Nov 1, 2018 |
| FCH Rural Health Clinic Graham |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Oct 14, 2020 Oct 14, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040819000032 | TX | Part B Supplier - Clinic/Group Practice | 5890768675 |
Receives reassigned benefits from 42 practitioners Practice locations: Jacksboro, TX |
| O20100827000915 | TX | Part a Provider - Hospital | 5890768675 |
1 other NPI on this enrollment Practice locations: Bowie, TX; Jacksboro, TX |
| O20100831000407 | TX | Part a Provider - Hospital | 5890768675 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Jacksboro, TX |
National Provider Directory
Interoperability endpoints
- jlockyer@direct.fchtexas.com
- bshepherd@direct.fchtexas.com
- asantos@direct.fchtexas.com
- ecrutcher@direct.fchtexas.com
- jjohnson@direct.fchtexas.com
- rcooper@direct.fchtexas.com
- jsmith@direct.fchtexas.com
- jdunn@direct.fchtexas.com
- pgafford@direct.fchtexas.com
- sagarwal@direct.fchtexas.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | TX | ||
| General Acute Care Hospital | 282N00000X | 000046 | TX | |
| General Acute Care Hospital | 282N00000X | 100322 | TX | Yes |
| Certified Registered Nurse Anesthetist |
367500000X | TX |
Addresses
Primary practice location
215 Chisholm TRL
Jacksboro, TX 76458
Mailing address
215 Chisholm TRL
Jacksboro, TX 76458-1403
Phone (940) 567-6633
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 119874903 | Medicaid | TX | |
| 119874904 | Medicaid | TX | |
| 119874905 | Medicaid | TX | |
| 119874902 | Medicaid | TX | |
| HH0054 | Other | TX | BC/BS PROVIDER NUMBER |
Other names
- FAITH COMMUNITY HOSPITAL
Other providers in Jacksboro, TX
- Babu Hosakote Subrahmanyam
- Jack County Hospital District
- Jack County Hospital District
- Jack County Hospital District
- Jack County Hospital District
- Jack County Hospital District
- Jacksboro Assisted Living, Inc.
- Jacksboro Health Care Center
- Jacksboro Independent School District
- Syed M Jamal
All providers in Jacksboro, TX · General Acute Care Hospital in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2021. 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.