1548269590 NPI number — CHILLICOTHE HOSPITAL

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 1548269590 NPI number — CHILLICOTHE HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILLICOTHE HOSPITAL
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:
CHILLICOTHE FAMILY CLINIC
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:
1548269590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 370
Provider Second Line Business Mailing Address:
BOX 370
Provider Business Mailing Address City Name:
CHILLICOTHEE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79225-0370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-852-5131
Provider Business Mailing Address Fax Number:
940-852-5252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 AVENUE I
Provider Second Line Business Practice Location Address:
BOX 370
Provider Business Practice Location Address City Name:
CHILLICOTHEE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79225-0370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-852-5131
Provider Business Practice Location Address Fax Number:
940-852-5252
Provider Enumeration Date:
07/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
BRANDI
Authorized Official Middle Name:
ROXANNE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
918-616-9953

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  00D13V , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282NC0060X , with the licence number: 451326 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 111624601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00D13V . This is a "CLINIC MEDICARE #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 154632701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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