NPIMap

Organization Active NPI

Special Health Resources for Texas, Inc.

Doing business as All for Kids Clinic

  • Federally Qualified Health Center (FQHC)
  • Texarkana, AR
National Provider Identifier
1942665112
Registry record updated Dec 15, 2015
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.
Doing business as
All for Kids Clinic
Practice address
300 E 6TH St
Texarkana, AR 71854-5207
Phone
(870) 779-6000
Fax
(870) 779-6125
NPI assigned
Dec 15, 2015
Last updated
Dec 15, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
SPECIAL HEALTH RESOURCES FOR TEXAS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 15, 2015

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

Authorized official

Name
Kim Nesvig
Title
Ceo
Phone
(903) 234-0776

Specialties & licenses 1

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

Addresses

Primary practice location

300 E 6TH St
Texarkana, AR 71854-5207

Mailing address

PO Box 2709
Longview, TX 75606-2709
Phone (903) 234-0776

Other names 1

  • ALL FOR KIDS CLINIC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160627001837 AR Part A Provider - Federally Qualified Health Center (FQHC) 1355326158 Practice locations: Texarkana, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942665112. Details of each certification follow.

Federally qualified health center certification: CCN 041916

Legal name
SPECIAL HEALTH RESOURCES FOR TEXAS, INCORPORATED
Doing business as
ALL FOR KIDS CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 18, 2016
Last certification
Mar 18, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 10, 1991 in TX
Enrollment address
300 E 6TH St
Texarkana, AR 71854-5207

Other NPIs with the same Medicare PAC ID 10

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

National Provider Directory

National Provider Directory
Tax ID family
Special HLTH Resources for11 organizations share this tax ID, including this one
Part of
Special HLTH Resources for

Other organizations with this tax ID 10

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

Locations

3150 Clarksville St
Paris, TX 75460
Phone (903) 784-2571

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 Corporation, Non-profit Other Jan 4, 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, 2022
Shaun'Ta Whitehead Individual Corporate OfficerCeo Oct 7, 2022
Corporate DirectorCeo Oct 1, 2022
W-2 Managing EmployeeCeo Oct 7, 2022
Lupe Tobar Individual Corporate DirectorBoard Chair Jun 30, 2020
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
Special Health Resources for Texas, IncorporatedLongview, TX, CCN 741936 Federally qualified health center Other Nov 16, 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 3

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": "1450137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450137600000",
    "number": "1942665112",
    "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": "903-234-0776",
            "fax_number": "903-234-9769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E 6TH ST",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718545207",
            "telephone_number": "870-779-6000",
            "fax_number": "870-779-6125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIAL HEALTH RESOURCES FOR TEXAS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPECIAL HEALTH RESOURCES FOR TEXAS, INC.",
        "enumeration_date": "2015-12-15",
        "last_updated": "2015-12-15",
        "status": "A",
        "authorized_official_last_name": "NESVIG",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "903-234-0776"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ALL FOR KIDS CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Texarkana, AR

Sources for this page

Verify at the official NPI Registry.