1255370474 NPI number — MCCAMEY COUNTY HOSPITAL DISTRICT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255370474 NPI number — MCCAMEY COUNTY HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCCAMEY 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:
Provider Other Organization Name Type Code:
6
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:
1255370474
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MC CAMEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79752-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-652-8626
Provider Business Mailing Address Fax Number:
432-652-4008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 S. HWY 305
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCCAMEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-652-8626
Provider Business Practice Location Address Fax Number:
432-652-4008
Provider Enumeration Date:
06/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GULIHUR
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
432-652-8626

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  458681 , 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: 063567401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 063567402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111780100 . This is a "FIRST CARE-HOSP RHC PHYS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 137325 . This is a "SUPERIOR-HOSP BASED RHC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00DT94 . This is a "BCBS RHC PHYSICIAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 122439 . This is a "SUPERIOR-RHC PHYSICIAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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