1306052089 NPI number — CASTRO COUNTY HOSPITAL DISTRICT

Table of content: (NPI 1306052089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306052089 NPI number — CASTRO COUNTY HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASTRO COUNTY HOSPITAL DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEDICAL CENTER OF DIMMITT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306052089
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 949
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DIMMITT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79027-0949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-647-2194
Provider Business Mailing Address Fax Number:
806-647-3769

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 W HALSELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DIMMITT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79027-1846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-647-2194
Provider Business Practice Location Address Fax Number:
806-647-3769
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FLOOD
Authorized Official First Name:
NATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
806-647-2191

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 063566602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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