Jack County Hospital District
Organization Active NPI Rural Health Clinic/Center · Alvord, TX
NPI 1831674209 · NPPES record last updated Oct 1, 2018
Key facts
- NPI
- 1831674209
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- JACK COUNTY HOSPITAL DISTRICT
- Practice address
- 115 E Bypass 287
Alvord, TX 76225-7778 - Phone
- (940) 427-2858
- NPI assigned
- Oct 1, 2018
- Organization subpart
- No
Authorized official
- Name
- Dawn Jones
- Title
- Fiscal Services Director
- Phone
- (940) 216-2262
Owners & managing parties with NPI records 2
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 13
Member of 1
Related certifications (CCN) 2
Change of ownership 1
Facilities with the same owner 8
Practitioners 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
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
- Other · Non-profit
- Enrollment address
- 115 E Bypass 287
Alvord, TX 76225-7778 - Related CCNs
- 450241
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| James Hammond |
Corporate Director |
Nov 1, 2018 | |
| Mark Maples |
Corporate Director |
Nov 1, 2018 | |
| Lori McBrayer |
Corporate Director |
Nov 1, 2018 | |
| Leslie Chalmers |
Corporate Director |
Jan 1, 2020 | |
| Larry Hopwood |
Corporate Director |
Nov 1, 2018 | |
| Jack County Hospital District |
5% Or Greater Direct Ownership Interest | Nov 1, 2018 | 100% |
| Operational/Managerial Control | Nov 1, 2018 | 100% | |
| Kim Lee |
Corporate Director |
Nov 1, 2018 | |
| W-2 Managing Employee |
Nov 1, 2018 | ||
| Frank L Beaman |
Corporate Director |
Nov 1, 2018 | |
| W-2 Managing Employee |
Nov 1, 2018 | ||
| Trina D Johnson |
W-2 Managing Employee |
Oct 1, 2024 |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Nov 1, 2018 | Change of Ownership |
Alvord Medical Clinic, PA |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20181020000227 | TX | Part a Provider - Rural Health Clinic | 4587842315 | Practice locations: Alvord, TX |
National Provider Directory
- Tax ID family
- Jack County Hospital District
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
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
- FCH RURAL HEALTH CLINIC ALVORD
Other providers in Alvord, TX
- Justin Wade Farrar
- Amanda May Gibbs
- Halo Cares Transport LLC
- Susan R Hansford-Orsburn
- Christine Lashell Hopson
- Dana Lee
- Cherami Mallett
- Amanda Pendley
- S and J Alvord Pharmacy
- Sonorus Medical Imaging, LLC
All providers in Alvord, 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 1, 2018. 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.