Pam Squared at Texarkana, LLC
Organization Active NPI Long Term Care Hospital · Texarkana, TX
NPI 1942601547 · NPPES record last updated Oct 20, 2016
Key facts
- NPI
- 1942601547
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Long Term Care Hospital 282E00000X
- Legal business name
- PAM SQUARED AT TEXARKANA, LLC
- Practice address
- 1000 Pine St
6TH Floor
Texarkana, TX 75501-5100 - Phone
- (903) 798-7600
- NPI assigned
- Sep 15, 2014
- Organization subpart
- No
Authorized official
- Name
- Mr. Anthony F. Misitano
- Title
- President
- Phone
- (717) 731-9660
Other NPIs on the same Medicare enrollment 1
Affiliated clinicians 5
-
Candace L Baird, APRN, FNP-C
Medicare Care Compare: Long-term care hospital
- Listed as
- Post Acute Medical Specialty Hospital of Texarkana
- Ownership
- For profit
- Certified
- Feb 1, 1999
- Medicare certification status
- Active
- Beds
- 49
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Hospital certification: CCN 452061
- Legal name
- PAM SQUARED AT TEXARKANA LLC
- Doing business as
- PAM SPECIALTY HOSPITAL OF TEXARKANA NORTH
- Certification status
- Active
- Provider type (POS)
- Hospital – Long-term
- Participating since
- Feb 1, 1999
- Last certification
- Jun 7, 2018
- Beds
- 49
- Ownership / control type
- Private (for profit)
- Most recent change of ownership
- Nov 3, 2014 (1 total)
- Organization structure
- LLC · Proprietary
- Incorporated
- Aug 25, 2014 in PA
- Enrollment address
- 2400 St Michael Dr 2ND Floor
Pam Specialty Hospital of Texarkana North
Texarkana, TX 75503-2374 - Hospital subgroups
- Long-term
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Karick E Stober |
Corporate Officer |
Sep 1, 2014 | |
| Anthony F Misitano |
5% Or Greater Indirect Ownership Interest | Oct 1, 2021 | 65.67% |
| Corporate Officer |
Sep 1, 2014 | ||
| Pam Cubed LLC |
Other | Apr 1, 2024 | |
| Wells Fargo Bank, N.a. |
5% Or Greater Security Interest | Jul 23, 2024 | |
| Jay Lindsey |
W-2 Managing Employee | Jul 31, 2023 | |
| Brittany Misitano |
Corporate Officer | Apr 2, 2026 | |
| Pam Squared, LLC |
5% Or Greater Direct Ownership Interest | Nov 3, 2014 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20141217000656 | TX | Part a Provider - Hospital | 5193048577 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Texarkana, TX |
National Provider Directory
Locations
2400 Saint Michael Dr
Fl 2
Texarkana, TX 75503
Phone (903) 614-7600
1000 Pine St
Fl 6
Texarkana, TX 75501
Phone (903) 798-6000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Long Term Care Hospital | 282E00000X | Yes |
Addresses
Primary practice location
1000 Pine St
6TH Floor
Texarkana, TX 75501-5100
Mailing address
1828 Good Hope Rd
Suite 102
Enola, PA 17025-1233
Phone (717) 731-9660
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 357622501 | Medicaid | TX | |
| 200645170 B | Medicaid | OK | |
| 208485105 | Medicaid | AR | |
| 357622502 | Medicaid | TX |
Other names
- PAM Specialty Hospital of Texarkana South
Other providers in Texarkana, TX
- Pain Treatment Centers of America, PLLC
- Palliative Connections of Texas Inc
- Pallicare Health, PLLC
- Pallicare, Inc
- Pam Squared at Texarkana, LLC
- Pappas Medical Clinic PA
- Rosamma G Parangimalil
- Mukti Parbhoo
- Stephen R Parish
- Colton Parker
All providers in Texarkana, TX · Long Term Care Hospital in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 20, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.