1003810698 NPI number — COUNTY OF HARDEMAN

Table of content: (NPI 1003810698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003810698 NPI number — COUNTY OF HARDEMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF HARDEMAN
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:
Provider Other Organization Name Type Code:
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:
1003810698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUANAH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79252-0030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-473-0927
Provider Business Mailing Address Fax Number:
832-778-5040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 MERCER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUANAH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-473-0920
Provider Business Practice Location Address Fax Number:
832-877-5040
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
INGRAM
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
COUNTY JUDGE
Authorized Official Telephone Number:
940-663-2911

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  099006 , 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: 000499601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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