NPIMap

Organization Active NPI

Palacios Community Medical Center

Doing business as Mid Coast Medical Clinic-Palacios

  • Rural Health Clinic/Center
  • Palacios, TX
National Provider Identifier
1942773874
Registry record updated Dec 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PALACIOS COMMUNITY MEDICAL CENTER
Doing business as
Mid Coast Medical Clinic-Palacios
Practice address
307 Green Ave
Palacios, TX 77465-3213
Phone
(361) 972-2000
Fax
(361) 972-2009
NPI assigned
Jan 3, 2019
Last updated
Dec 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2024

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

Authorized official

Name
David H Mak
Title
Chief Financial Officer
Phone
(713) 569-7370

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

307 Green Ave
Palacios, TX 77465-3213

Mailing address

303 Sandy Corner Rd
El Campo, TX 77437-9535
Phone (979) 543-5510

Other names 1

  • MID COAST MEDICAL CLINIC-PALACIOS Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140813001385 TX Part B Supplier - Clinic/Group Practice 6406021765 Receives reassigned benefits from 38 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wharton, TX; Palacios, TX; Mason, TX; Louise, TX; Ganado, TX; El Campo, TX; Boling, TX; Blessing, TX…
O20250312001859 TX Part A Provider - Rural Health Clinic 0840278164 Practice locations: Palacios, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942773874. Details of each certification follow.

Rural health clinic certification: CCN 458820

Legal name
PALACIOS COMMUNITY MEDICAL CENTER
Doing business as
MID COAST MEDICAL CLINIC-PALACIOS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 15, 2001
Last certification
Jun 17, 2025
Ownership / control type
2A
Most recent change of ownership
Jan 1, 2025 (2 total)
Organization structure
OtherNon-profit
Enrollment address
307 Green Ave
Palacios, TX 77465-3213
Related CCNs
451332

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

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 23

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

View all 23

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
45D1097368Mid Coast Medical Clinic-Palacios307 Green Avenue, Palacios, TX 77465Certificate of waiverMar 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Palacios Community Medical3 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 4

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

NameRoleSinceShare
Palacios Community Medical Center Organization, Palacios, TX For-profit Operational/Managerial Control Jan 1, 2025
David Mak Individual Corporate DirectorChief Financial Officer Jan 1, 2025
W-2 Managing EmployeeChief Financial Officer Jan 1, 2025
Operational/Managerial ControlChief Financial Officer Jan 1, 2025
Brett Kirkham Individual Corporate DirectorChief Executive Officer Jan 1, 2025
W-2 Managing EmployeeChief Executive Officer Jan 1, 2025
Operational/Managerial ControlChief Executive Officer Jan 1, 2025
Mid Coast Health System Organization, El Campo, TX For-profit, Chain home office Operational/Managerial Control Jan 1, 2025

Owners & managing parties with NPI records 2

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
Palacios Community Medical CenterPalacios, TX, CCN 451332 Hospital Other Mar 1, 2002
Palacios Community Medical CenterPalacios, TX, CCN 45Z332 Hospital Operational/Managerial Control
Other		 Mar 1, 2022
Mar 1, 2002

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 7

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

Change-of-ownership history 2

DateEventCounterparty
Jan 1, 2025 Change of OwnershipThis provider was the buyer Mid Coast Medical Clinic-PalaciosCCN 458820, TX, NPI 1942773874
Jan 1, 2025 Change of OwnershipThis provider was the seller Mid Coast Medical Clinic-PalaciosCCN 458820, TX, NPI 1942773874

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1546473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735257600000",
    "number": "1942773874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 SANDY CORNER RD",
            "city": "EL CAMPO",
            "state": "TX",
            "postal_code": "774379535",
            "telephone_number": "979-543-5510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 GREEN AVE",
            "city": "PALACIOS",
            "state": "TX",
            "postal_code": "774653213",
            "telephone_number": "361-972-2000",
            "fax_number": "361-972-2009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALACIOS COMMUNITY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-03",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A",
        "authorized_official_last_name": "MAK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "713-569-7370"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MID COAST MEDICAL CLINIC-PALACIOS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MID COAST MEDICAL CLINIC-PALACIOS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palacios, TX

Sources for this page

Verify at the official NPI Registry.