Jack County Hospital District
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Jacksboro, TX
NPI 1790865293 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1790865293
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- License
- 100322 (TX)
- Legal business name
- JACK COUNTY HOSPITAL DISTRICT
- Practice address
- 215 Chisholm TRL
Jacksboro, TX 76458-1403 - Phone
- (940) 567-6633
- Fax
- (940) 567-2895
- NPI assigned
- Oct 17, 2006
- 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 1
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 13
Related certifications (CCN) 2
Facilities with the same owner 8
Practitioners 20
-
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
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
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 | |
| 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 | ||
| Trina D Johnson |
W-2 Managing Employee |
Oct 1, 2024 |
All facility ownership & control disclosures 8
| Facility | Type | Role | Since |
|---|---|---|---|
| Faith Community Hospital |
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 |
|---|---|---|---|---|
| O20100831000407 | TX | Part a Provider - Hospital | 5890768675 |
1 other NPI on this enrollment Practice locations: Jacksboro, TX |
National Provider Directory
- Tax ID family
- Jack County Hospital District
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 45U241 | TN | |
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 100322 | TX | Yes |
Addresses
Primary practice location
215 Chisholm TRL
Jacksboro, TX 76458-1403
Mailing address
215 Chisholm TRL
Jacksboro, TX 76458-1403
Phone (940) 567-6633
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790865293 | Other | TX | NPI |
Other names
- FAITH COMMUNITY HOSPITAL
Other providers in Jacksboro, TX
- 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
- Lara M. Pierce, MD PLLC
All providers in Jacksboro, TX · Medicare Defined Swing Bed Hospital Unit in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. 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.