NPIMap

Organization Active NPI

Lavaca Hospital District

Doing business as Lavaca Family Health Clinic

  • Rural Health Clinic/Center
  • Hallettsville, TX
National Provider Identifier
1871555409
Registry record updated Oct 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
LAVACA HOSPITAL DISTRICT
Doing business as
Lavaca Family Health Clinic
Practice address
1406 N Texana St
Hallettsville, TX 77964-2009
Phone
(361) 798-1200
Fax
(361) 798-3128
NPI assigned
Apr 6, 2006
Last updated
Oct 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2020

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

Authorized official

Name
Jack S Bowen
Title
Administrator
Phone
(361) 798-3671

Specialties & licenses 1

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

Addresses

Primary practice location

1406 N Texana St
Hallettsville, TX 77964-2009

Mailing address

1406 N Texana St
Hallettsville, TX 77964-2009
Phone (361) 798-1200

Other identifiers 1

IdentifierTypeStateIssuer
126884905MedicaidTX

Other names 1

  • Lavaca Family Health Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050428000044 TX Part A Provider - Rural Health Clinic 1153211750 Practice locations: Hallettsville, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871555409. Details of each certification follow.

Rural health clinic certification: CCN 673994

Legal name
LAVACA HOSPITAL DISTRICT
Doing business as
LAVACA FAMILY HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 4, 1992
Last certification
May 22, 2017
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
1406 N Texana St
Hallettsville, TX 77964-2021
Related CCNs
451376

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Lavaca Medical Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

1406 N Texana St
Hallettsville, TX 77964
Phone (361) 798-3671

1406 N Texana St
Ste D
Hallettsville, TX 77964
Phone (361) 798-1200

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Tracy Green Individual Corporate Director Jan 1, 2014
Jack Bowen Individual Corporate Officer Jul 22, 2015
W-2 Managing Employee Jul 22, 2015

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603152000000",
    "number": "1871555409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 N TEXANA ST",
            "city": "HALLETTSVILLE",
            "state": "TX",
            "postal_code": "779642009",
            "telephone_number": "361-798-1200",
            "fax_number": "361-798-3128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 N TEXANA ST",
            "city": "HALLETTSVILLE",
            "state": "TX",
            "postal_code": "779642009",
            "telephone_number": "361-798-1200",
            "fax_number": "361-798-3128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAVACA HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-06",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A",
        "authorized_official_last_name": "BOWEN",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "361-798-3671"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126884905",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lavaca Family Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hallettsville, TX

Sources for this page

Verify at the official NPI Registry.