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JACKSONVILLE HOSPITAL LLC
NPI 1861991226
Clinic/Center - Rural Health in Jacksonville, TX

Active since February 12, 2018CLIA Certified · 3 labs
203 NACOGDOCHES ST STE 280, JACKSONVILLE, TX 75766(903) 541-5396(903) 591-5393 Get Directions Write a Review

NPPES record last updated: October 1, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Jacksonville Hospital Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACKSONVILLE HOSPITAL LLC (NPI 1861991226) is a healthcare organization registered as a rural health in Jacksonville, Texas and active in the NPI registry since February 2018. The organization holds 3 active CLIA laboratory certificates and lists Stephen C Petrovich, Evp, as its authorized official.

NPPES Registry Identity

NPI1861991226
Entity TypeOrganization
Primary Taxonomy261QR1300X
Legal Business NameJACKSONVILLE HOSPITAL LLC
Location Address203 NACOGDOCHES ST STE 280Jacksonville, TX 75766-2444
Mailing Address340 Seven Springs Way Ste 100Brentwood, TN 37027-5697 · (615) 296-3000 · Fax (615) 296-6227
Phone(903) 541-5396
Fax(903) 591-5393
Organization SubpartYesParent: Ahs East Texas Health System, Llc
Authorized OfficialStephen C PetrovichEvp · (615) 296-3000
Enumeration DateFebruary 12, 2018
Last NPPES UpdateOctober 1, 2023
NPPES CertifiedOctober 1, 2023
✔ NPI 1861991226 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities
Taxonomy Code261QR1300X
203 NACOGDOCHES ST STE 280, Jacksonville, TX 75766
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2010097

Jacksonville Hospital, LLC · Rusk, TX
Active · expires Jul 19, 2028
CLIA Number45D2010097
Laboratory TypeRural Health Clinic
Certificate Effective DateJuly 20, 2026
Certificate Expiration DateJuly 19, 2028
Laboratory DirectorLucy Ryan Haberthier
Laboratory Phone(903) 541-5396
Laboratory LocationJacksonville Hospital, LLC1325 North Dickinson, Rusk, TX 75785
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 45D2003095

Jacksonville Hospital, LLC · Frankston, TX
Active · expires Jun 3, 2028
CLIA Number45D2003095
Laboratory TypeRural Health Clinic
Certificate Effective DateJune 4, 2026
Certificate Expiration DateJune 3, 2028
Laboratory DirectorMichael Racs
Laboratory Phone(903) 541-5396
Laboratory LocationJacksonville Hospital, LLC580 North Frankston Highway, Frankston, TX 75763
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 45D1095752

Jacksonville Hospital, LLC · Jacksonville, TX
Active · expires Oct 30, 2026
CLIA Number45D1095752
Laboratory TypePhysician Office
Certificate Effective DateOctober 31, 2024
Certificate Expiration DateOctober 30, 2026
Laboratory DirectorSarah Tyner
Laboratory Phone(903) 541-5396
Laboratory LocationJacksonville Hospital, LLC203 Nacogdoches Suite 280 Attn Laboratory - Susan Campbell, Jacksonville, TX 75766
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KENYA SEKONI ETIM M.D.
Family Medicine (Adult Medicine)
203 NACOGDOCHES ST STE 280
JACKSONVILLE, TX 75766
Cherokee County (903) 541-5396
ZACHARY TAYLOR PAGE MD
Family Medicine
203 NACOGDOCHES ST STE 280
JACKSONVILLE, TX 75766
Cherokee County (903) 541-5380
SARAH ELIZABETH MURPHY
Nurse Practitioner
203 NACOGDOCHES ST STE 280
JACKSONVILLE, TX 75766
Cherokee County (903) 541-5380
SHAYNA BURDEAUX DO
Obstetrics & Gynecology
203 NACOGDOCHES ST STE 280
JACKSONVILLE, TX 75766
Cherokee County (903) 541-5396
SHAZA MOUSSA MD
Internal Medicine
203 NACOGDOCHES ST STE 280
JACKSONVILLE, TX 75766
Cherokee County (903) 541-5380
JUSTIN M MCINNIS MD
Family Medicine
203 NACOGDOCHES ST STE 280
JACKSONVILLE, TX 75766
Cherokee County (903) 541-5390
ADRIANA SANDERS PA
Physician Assistant
203 NACOGDOCHES ST STE 280
JACKSONVILLE, TX 75766
Cherokee County (903) 541-5380

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacksonville Hospital LLC's NPI number?

The NPI number for Jacksonville Hospital LLC is 1861991226. It was assigned to this organization in the NPPES registry on February 12, 2018.

Where is Jacksonville Hospital LLC located?

Jacksonville Hospital LLC is located at 203 Nacogdoches St Ste 280, Jacksonville, TX 75766. The listed phone number is (903) 541-5396.

What is Jacksonville Hospital LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.

Does Jacksonville Hospital LLC hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Jacksonville Hospital LLC accept?

Health plans from Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 3 other insurers list Jacksonville Hospital LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jacksonville Hospital LLC was last updated on October 1, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.