NPIMap

Organization Active NPI

Pecos County Memorial Hospital District

  • Rural Health Clinic/Center
  • Fort Stockton, TX
National Provider Identifier
1831973072
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PECOS COUNTY MEMORIAL HOSPITAL DISTRICT
Practice address
387 W Ih 10
Fort Stockton, TX 79735
Phone
(432) 336-2058
NPI assigned
Aug 21, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2023

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

Authorized official

Name
Betsy L Briscoe
Title
Chief Executive Officer
Phone
(432) 336-4201

Specialties & licenses 1

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

Addresses

Primary practice location

387 W Ih 10
Fort Stockton, TX 79735

Mailing address

387 W Ih 10
Fort Stockton, TX 79735
Phone (432) 336-2058

Other names 1

  • FAMILY CARE CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231003001377 TX Part A Provider - Rural Health Clinic 3173977477 Practice locations: Fort Stockton, TX

Rural health clinic certification: CCN 458547

Legal name
PECOS COUNTY MEMORIAL HOSPITAL DISTRICT
Doing business as
FAMILY CARE CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 29, 1994
Last certification
Jun 7, 2016
Ownership / control type
2A
Organization structure
OtherNon-profit
Enrollment address
387 W Ih 10
Fort Stockton, TX 79735
Related CCNs
450178

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
Pecos County Memorial Hospital District6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Rebecca Ureta Individual Corporate DirectorChief Financial Officer Jul 1, 2023
W-2 Managing EmployeeChief Financial Officer Jul 1, 2023
Operational/Managerial ControlChief Financial Officer Jul 1, 2023
Armando Mandujano Individual Corporate DirectorBoard Member Jul 1, 2023
Matt Tarpley Individual Corporate DirectorBoard Member Jul 1, 2023
Lou Ann Tovar Individual Corporate DirectorBoard Member Jul 1, 2023
Betsy Briscoe Individual Corporate DirectorChief Executive Officer Jul 1, 2023
W-2 Managing EmployeeChief Executive Officer Jul 1, 2023
Operational/Managerial ControlChief Financial Officer Jul 1, 2023
Santiago Cantu Individual Corporate DirectorBoard Member Jul 1, 2023
Laura McKenzie Individual Corporate DirectorBoard Member Jul 1, 2023

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Pecos County Memorial Hospital DistrictFort Stockton, TX, CCN 451389 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jul 1, 2023
Jul 1, 2023
Pecos County Memorial HospitalFort Stockton, TX, CCN 45Z389 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jul 1, 2023
Jul 1, 2023
Pecos County Memorial Hospital Home Health & HospiceFort Stockton, TX, CCN 673107 Home health agency 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jun 1, 2023
Jun 1, 2023
Pecos County Memorial Hospital HospiceFort Stockton, TX, CCN 671732 Hospice 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jul 1, 2023
Jul 1, 2023

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Change-of-ownership history 1

DateEventCounterparty
Jul 1, 2023 Change of OwnershipThis provider was the buyer Family Care CenterCCN 458547, TX, NPI 1457307175

Change of ownership 1

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

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1692576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692576000000",
    "number": "1831973072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "387 W IH 10",
            "city": "FORT STOCKTON",
            "state": "TX",
            "postal_code": "79735",
            "telephone_number": "432-336-2058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "387 W IH 10",
            "city": "FORT STOCKTON",
            "state": "TX",
            "postal_code": "79735",
            "telephone_number": "432-336-2058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECOS COUNTY MEMORIAL HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-21",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-17",
        "status": "A",
        "authorized_official_last_name": "BRISCOE",
        "authorized_official_first_name": "BETSY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "432-336-4201"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Stockton, TX

Sources for this page

Verify at the official NPI Registry.