NPIMap

Organization Active NPI

Pecos County Memorial Hospital

Doing business as Family Care Center Walk in Clinic

  • Rural Health Clinic/Center
  • Fort Stockton, TX
National Provider Identifier
1851695316
Registry record updated Nov 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PECOS COUNTY MEMORIAL HOSPITAL
Doing business as
Family Care Center Walk in Clinic
Practice address
511 N Main St
Fort Stockton, TX 79735-5623
Phone
(432) 336-4544
Fax
(844) 315-6548
NPI assigned
Dec 27, 2010
Last updated
Nov 8, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
PECOS COUNTY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 8, 2019

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

Authorized official

Name
Mrs. Melissa Pena
Title
Director
Phone
(432) 336-4880

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

511 N Main St
Fort Stockton, TX 79735-5623

Mailing address

387 W I H 10
Fort Stockton, TX 79735-2700
Phone (432) 336-4213

Other identifiers 2

IdentifierTypeStateIssuer
0079AEOtherTXMEDICARE PART B
287117001MedicaidTX

Other names 1

  • FAMILY CARE CENTER WALK IN CLINIC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041122000269 TX Part B Supplier - Clinic/Group Practice 0446160733 Receives reassigned benefits from 24 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fort Stockton, TX; Sanderson, TX

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Sanderson Health Care C

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Jul 1, 2023 Change of OwnershipThis provider was the seller Family Care Center Walk in ClinicCCN 458894, TX, NPI 1205610557

Change of ownership 1

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

Practitioners & affiliated clinicians

Practitioners 4

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": "1293408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573171200000",
    "number": "1851695316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "387 W I H 10",
            "city": "FORT STOCKTON",
            "state": "TX",
            "postal_code": "797352700",
            "telephone_number": "432-336-4213",
            "fax_number": "432-336-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 N MAIN ST",
            "city": "FORT STOCKTON",
            "state": "TX",
            "postal_code": "797355623",
            "telephone_number": "432-336-4544",
            "fax_number": "844-315-6548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECOS COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PECOS COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2010-12-27",
        "last_updated": "2019-11-08",
        "status": "A",
        "authorized_official_last_name": "PENA",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "432-336-4880",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "0079AE",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287117001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY CARE CENTER WALK IN CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Stockton, TX

Sources for this page

Verify at the official NPI Registry.