NPIMap

Organization Active NPI

Special Health Resources for Texas, Inc

  • Federally Qualified Health Center (FQHC)
  • Longview, TX
National Provider Identifier
1922556067
Registry record updated Sep 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SPECIAL HEALTH RESOURCES FOR TEXAS, INC
Practice address
402 N 7TH St
Longview, TX 75601-6704
Phone
(903) 212-7170
Fax
(903) 212-7103
NPI assigned
Sep 19, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2016

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

Authorized official

Name
Mr. Kim Nesvig
Title
Executive Director
Phone
(903) 212-7170

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

402 N 7TH St
Longview, TX 75601-6704

Mailing address

PO Box 2709
Longview, TX 75606-2709
Phone (903) 212-7170

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040623001434 TX Part B Supplier - Clinic/Group Practice 1355326158 Receives reassigned benefits from 22 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Texarkana, TX; Tyler, TX; Paris, TX; Longview, TX; Jacksonville, TX
O20161115002688 TX Part A Provider - Federally Qualified Health Center (FQHC) 1355326158 Practice locations: Longview, TX

Federally qualified health center certification: CCN 741936

Legal name
SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 16, 2016
Last certification
Nov 16, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 10, 1991 in TX
Enrollment address
402 N 7TH Street
Longview, TX 75601-6704

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Tax ID family
Special Health Resources for Texas Inc11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

1300 Clinic Dr
Tyler, TX 75701
Phone (903) 593-1300

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AFADCA

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Roger Gardner Individual Corporate DirectorBoard Member Jun 25, 2019
Special Health Resources for Texas, Incorporated Organization, Longview, TX Corporation, Non-profit Other Nov 16, 2016
Briana Asberry Individual Corporate DirectorBoard Member Mar 2, 2021
Danny Rivers Individual Corporate DirectorBoard Treasurer May 29, 2018
Pamela Lewis Individual Corporate DirectorBoard Member Jun 30, 2020
Shaun'Ta Whitehead Individual Corporate OfficerCeo Oct 7, 2022
Corporate DirectorCeo Oct 7, 2022
W-2 Managing EmployeeCeo Oct 7, 2022
Lupe Tobar Individual Corporate DirectorMember of the Board of Directors Sep 1, 2014
Bobby Pierce Individual Corporate DirectorBoard Vice Chair Sep 25, 2018
Janine Wood Individual Corporate DirectorBoard Secretary Sep 24, 2019
Roque Capetillo Individual Corporate DirectorBoard Member Jun 30, 2020

Owners & managing parties with NPI records 10

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

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Midtown Clinic of TylerTyler, TX, CCN 741903 Federally qualified health center Other Jan 10, 1991
Special Health Resources for Texas, IncorporatedTexarkana, TX, CCN 741905 Federally qualified health center Operational/Managerial Control Jan 10, 1991
All for Kids ClinicTexarkana, AR, CCN 041916 Federally qualified health center Other Jan 4, 2016
Paris ClinicParis, TX, CCN 741977 Federally qualified health center Other Nov 20, 2017
Tyler Care ClinicTyler, TX, CCN 451017 Federally qualified health center Operational/Managerial Control Jan 10, 1991

Owned or controlled facilities with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1474243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474243200000",
    "number": "1922556067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2709",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756062709",
            "telephone_number": "903-212-7170",
            "fax_number": "903-212-7103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 N 7TH ST",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756016704",
            "telephone_number": "903-212-7170",
            "fax_number": "903-212-7103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIAL HEALTH RESOURCES FOR TEXAS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-19",
        "last_updated": "2016-09-19",
        "status": "A",
        "authorized_official_last_name": "NESVIG",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "903-212-7170",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, TX

Sources for this page

Verify at the official NPI Registry.