1538150370 NPI number — SOUTH WHEELER COUNTY HOSPITAL DISTRICT

Table of content: (NPI 1538150370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538150370 NPI number — SOUTH WHEELER COUNTY HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH WHEELER 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:
SHAMROCK GENERAL HOSPITAL
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:
1538150370
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 S MAIN ST
Provider Second Line Business Mailing Address:
P.O. BOX 511
Provider Business Mailing Address City Name:
SHAMROCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79079-2820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-256-2114
Provider Business Mailing Address Fax Number:
806-256-2423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHAMROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79079-2820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-256-2114
Provider Business Practice Location Address Fax Number:
806-256-2423
Provider Enumeration Date:
11/01/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FIRES
Authorized Official First Name:
WILEY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
ADMINISTRATOR/CEO
Authorized Official Telephone Number:
806-256-2114

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  571 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 571 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0921793-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0921793-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1211930-05 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".