NPIMap

Organization Active NPI

Jack County Hospital District

Doing business as FCH Rural Health Clinic Alvord

  • Rural Health Clinic/Center
  • Alvord, TX
National Provider Identifier
1831674209
Registry record updated Oct 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
JACK COUNTY HOSPITAL DISTRICT
Doing business as
FCH Rural Health Clinic Alvord
Practice address
115 E Bypass 287
Alvord, TX 76225-7778
Phone
(940) 427-2858
NPI assigned
Oct 1, 2018
Last updated
Oct 1, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2018

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

Authorized official

Name
Dawn Jones
Title
Fiscal Services Director
Phone
(940) 216-2262

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

115 E Bypass 287
Alvord, TX 76225-7778

Mailing address

215 Chisholm TRL
Jacksboro, TX 76458-1403
Phone (940) 216-2262

Other names 1

  • FCH RURAL HEALTH CLINIC ALVORD Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181020000227 TX Part A Provider - Rural Health Clinic 4587842315 Practice locations: Alvord, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831674209. Details of each certification follow.

Rural health clinic certification: CCN 673468

Legal name
JACK COUNTY HOSPITAL DISTRICT
Doing business as
FCH RURAL HEALTH CLINIC ALVORD
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 1, 2018
Last certification
Jun 6, 2017
Ownership / control type
1C
Organization structure
OtherNon-profit
Enrollment address
115 E Bypass 287
Alvord, TX 76225-7778
Related CCNs
450241

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Faith Community Hospital14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Member of 1

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

Locations

115 E Bypass 287
Alvord, TX 76225
Phone (940) 427-2858

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
James Hammond Individual Corporate DirectorMember Nov 1, 2018
Mark Maples Individual Corporate DirectorSecretary Nov 1, 2018
Lori McBrayer Individual Corporate DirectorPresident Nov 1, 2018
Leslie Chalmers Individual Corporate DirectorEdc Director Jan 1, 2020
Larry Hopwood Individual Corporate DirectorMember Nov 1, 2018
Jack County Hospital District Organization, Jacksboro, TX 5% Or Greater Direct Ownership Interest Nov 1, 2018 100%
Operational/Managerial Control Nov 1, 2018 100%
Kim Lee Individual Corporate DirectorChief Financial Officer Nov 1, 2018
W-2 Managing EmployeeChief Financial Officer Nov 1, 2018
Frank L Beaman Individual Corporate DirectorCeo Nov 1, 2018
W-2 Managing EmployeeCeo Nov 1, 2018
Trina D Johnson Individual W-2 Managing EmployeeFinancial Analyst Oct 1, 2024

Owners & managing parties with NPI records 2

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

Facilities with the same owner 8

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

Change-of-ownership history 1

DateEventCounterparty
Nov 1, 2018 Change of OwnershipThis provider was the buyer Alvord Medical Clinic, PACCN 453934, TX, NPI 1740237148

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1538352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538352000000",
    "number": "1831674209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 CHISHOLM TRL",
            "city": "JACKSBORO",
            "state": "TX",
            "postal_code": "764581403",
            "telephone_number": "940-216-2262",
            "fax_number": "940-567-2895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 E BYPASS 287",
            "city": "ALVORD",
            "state": "TX",
            "postal_code": "762257778",
            "telephone_number": "940-427-2858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-01",
        "last_updated": "2018-10-01",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "FISCAL SERVICES DIRECTOR",
        "authorized_official_telephone_number": "940-216-2262"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FCH RURAL HEALTH CLINIC ALVORD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Alvord, TX

Sources for this page

Verify at the official NPI Registry.