NPIMap

Organization Active NPI

Columbus Community Hospital

Doing business as Four Oaks Medical Clinic

  • Rural Health Clinic/Center
  • Columbus, TX
National Provider Identifier
1932158367
Registry record updated Jul 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COLUMBUS COMMUNITY HOSPITAL
Doing business as
Four Oaks Medical Clinic
Practice address
109 Shult Dr
Columbus, TX 78934-3015
Phone
(979) 732-5794
Fax
(979) 732-5795
NPI assigned
May 10, 2006
Last updated
Jul 19, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2022

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

Authorized official

Name
Mr. James E. Vanek
Title
Chief Executive Officer
Phone
(979) 493-7650

Specialties & licenses 1

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

Addresses

Primary practice location

109 Shult Dr
Columbus, TX 78934-3015

Mailing address

109 Shult Dr
Columbus, TX 78934-3009
Phone (979) 732-5794

Other identifiers 3

IdentifierTypeStateIssuer
1268898-02OtherTXEPSDT
1268898-04MedicaidTX
453415OtherTXMEDICARE

Other names 1

  • FOUR OAKS MEDICAL CLINIC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100202000789 TX Part A Provider - Rural Health Clinic 1557250446 Practice locations: Columbus, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932158367. Details of each certification follow.

Rural health clinic certification: CCN 453415

Legal name
COLUMBUS COMMUNITY HOSPITAL
Doing business as
FOUR OAKS MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 20, 1992
Last certification
Dec 15, 2015
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Sep 29, 1975 in TX
Enrollment address
109 Shult Dr
Ste 101
Columbus, TX 78934-3015
Related CCNs
450370

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).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D0506400Four Oaks Medical Clinic109 Shult Dr # 102, Columbus, TX 78934Certificate of waiverSep 7, 2026

National Provider Directory

National Provider Directory
Tax ID family
Cuero Community Hospita3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Columbus Community Hospital Organization, Columbus, TX Operational/Managerial Control Jan 1, 2010
Jerry Haluska Individual Corporate DirectorDirector May 1, 2020
Curtiss Schonenberg Individual Corporate DirectorDirector May 1, 2020
Catharina Jamison Individual Corporate Director Jan 1, 2010
Pat Gillespie Individual Corporate Director Jan 1, 2010
Drew Lynch Individual Corporate DirectorDirector May 1, 2021
Chuck Rankin Individual Corporate DirectorDirector May 1, 2021
Gregory S Pritchett Individual W-2 Managing EmployeeCfo May 29, 2020 2%
Operational/Managerial ControlCfo Jun 5, 2020 5%
Dyann Lauzon Individual Corporate Director May 1, 2019
Brent Leftwich Individual Corporate Director May 1, 2019
James Vanek Individual 5% Or Greater Indirect Ownership InterestChief Executive Officer May 1, 2015
Corporate OfficerChief Executive Officer May 1, 2015
Operational/Managerial ControlChief Executive Officer May 1, 2015 100%
Lisa Moeller Individual Corporate DirectorBoard Director May 1, 2015

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Columbus Community HospitalColumbus, TX, CCN 450370 Hospital Operational/Managerial Control May 1, 2019
Columbus Medical ClinicColumbus, TX, CCN 458608 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 1, 2008
Jan 1, 2008

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658188800000",
    "number": "1932158367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 SHULT DR",
            "city": "COLUMBUS",
            "state": "TX",
            "postal_code": "789343009",
            "telephone_number": "979-732-5794",
            "fax_number": "979-732-5795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 SHULT DR",
            "city": "COLUMBUS",
            "state": "TX",
            "postal_code": "789343015",
            "telephone_number": "979-732-5794",
            "fax_number": "979-732-5795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBUS COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A",
        "authorized_official_last_name": "VANEK",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "979-493-7650",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EPSDT",
            "identifier": "1268898-02",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1268898-04",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "453415",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FOUR OAKS MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbus, TX

Sources for this page

Verify at the official NPI Registry.