NPIMap

Organization Active NPI

Jackson County Memorial Hospital Authority

  • Rural Health Clinic/Center
  • Altus, OK
National Provider Identifier
1972987014
Registry record updated Oct 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY
Practice address
101 S Park LN Ste 200
Altus, OK 73521-5731
Phone
(580) 379-6140
Fax
(580) 379-6149
NPI assigned
Jul 18, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2022

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

Authorized official

Name
Mr. Steve Hartgraves
Title
President/Ceo
Phone
(580) 379-5500

Specialties & licenses 1

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

Addresses

Primary practice location

101 S Park LN Ste 200
Altus, OK 73521-5731

Mailing address

1200 E Pecan St
Altus, OK 73521-6141
Phone (580) 379-5000

Other identifiers 1

IdentifierTypeStateIssuer
100699350PMedicaidOK

Other names 1

  • JCMH Women's Health Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150922001444 OK Part A Provider - Rural Health Clinic 1759293178 Practice locations: Altus, OK

Rural health clinic certification: CCN 373483

Legal name
JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY
Doing business as
JCMH WOMEN'S HEALTH ASSOCIATES
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 26, 2016
Last certification
Mar 27, 2025
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
in OK
Enrollment address
101 S Park Lane
Suite 200
Altus, OK 73521-5731
Related CCNs
370022

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

Other NPIs with the same Medicare PAC ID 8

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
37D0983906JCMH Women'S Health Associates101 S Park Lane, Altus, OK 73521Provider-performed microscopyMar 7, 2027

National Provider Directory

National Provider Directory
Tax ID family
J C M H11 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.

Member organizations 4

Organizations listed as members of this organization in the National Provider Directory.

Locations

101 S Park Ln
Altus, OK 73521
Phone (580) 379-6140

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Corwin Petzold Individual Corporate DirectorBoard Member Jul 24, 2006
Matt Coppock Individual Corporate DirectorBoard Member Mar 24, 2014
Elizabeth Renee Whiting Individual Corporate DirectorDirector of Medical Staff Services Jun 21, 2021
Rana Womack Individual Corporate DirectorBoard Member Aug 1, 2018
Gary Beach Individual Corporate DirectorBoard Member Aug 11, 2014
Steven L Hartgraves Individual Operational/Managerial ControlPresident/Ceo Mar 17, 2014 100%
John Chinnick Root Individual Corporate DirectorBoard Member Nov 19, 2018
Charlotte June Knight Individual Corporate OfficerChairman of the Board Aug 24, 2009
Mary Beth Hawkins Individual Corporate DirectorBoard Member Jul 1, 2020

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Jackson County Memorial HospitalAltus, OK, CCN 370022 Hospital 5% Or Greater Direct Ownership Interest Jul 1, 2010
Jackson County Memorial HospitalAltus, OK, CCN 37U022 Hospital 5% Or Greater Direct Ownership Interest Jul 1, 2010
Harmon Memorial HospitalHollis, OK, CCN 371338 Hospital 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2019
Harmon Memorial HospitalHollis, OK, CCN 37Z338 Hospital 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2019
Jackson County Memorial Hospital HospiceAltus, OK, CCN 377137 Home health agency Operational/Managerial Control (100%) Feb 1, 2012
Jackson County Memorial Hospital HospiceAltus, OK, CCN 371540 Hospice Operational/Managerial Control Jan 1, 2008

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 53

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

View all 53

NPI Registry JSON

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

{
    "created_epoch": "1437177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665014400000",
    "number": "1972987014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 E PECAN ST",
            "city": "ALTUS",
            "state": "OK",
            "postal_code": "735216141",
            "telephone_number": "580-379-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S PARK LN STE 200",
            "city": "ALTUS",
            "state": "OK",
            "postal_code": "735215731",
            "telephone_number": "580-379-6140",
            "fax_number": "580-379-6149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-18",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A",
        "authorized_official_last_name": "HARTGRAVES",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "580-379-5500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100699350P",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JCMH WOMEN'S HEALTH ASSOCIATES",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "JCMH Women's Health Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Altus, OK

Sources for this page

Verify at the official NPI Registry.