1326349986 NPI number — MID COAST MEDICAL CENTER - CENTRAL

Table of content: (NPI 1326349986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326349986 NPI number — MID COAST MEDICAL CENTER - CENTRAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID COAST MEDICAL CENTER - CENTRAL
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:
MID COAST MEDICAL CENTER - CENTRAL
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:
1326349986
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W OLLIE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78643-2628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-247-5040
Provider Business Mailing Address Fax Number:
325-248-2109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 W OLLIE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78643-2628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-247-5040
Provider Business Practice Location Address Fax Number:
325-248-2109
Provider Enumeration Date:
11/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
TUDOR
Authorized Official First Name:
NATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
931-252-1641

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 100090 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 220798702 . This is a "MEDICAID ASC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 220798701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 220798703 . This is a "MEDICAID THSTEPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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