1528557410 NPI number — OCHILTREE HOSPITAL DISTRICT

Table of content: (NPI 1528557410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528557410 NPI number — OCHILTREE HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCHILTREE 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:
THE DEWITT FAMILY PRACTICE
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:
1528557410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3101 GARRETT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERRYTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79070-5323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-435-3606
Provider Business Mailing Address Fax Number:
806-435-2813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3020 GARRETT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERRYTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79070-5322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-648-9355
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2018

Additional Information

Authorized Official

Authorized Official Last Name:
JUDICE
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
PAIGE
Authorized Official Title or Position:
INTERIM CEO
Authorized Official Telephone Number:
806-435-3606

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  98 , 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: 395971001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 395971002 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101618100 . This is a "FIRSTCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0097ES . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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