1639176456 NPI number — DALLAM-HARTLEY COUNTIES HOSPITAL DISTRICT

Table of content: (NPI 1639176456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639176456 NPI number — DALLAM-HARTLEY COUNTIES HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DALLAM-HARTLEY COUNTIES 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:
COON MEMORIAL 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:
1639176456
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2014
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALHART
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79022-6014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-244-4571
Provider Business Mailing Address Fax Number:
806-244-5013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1411 DENVER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALHART
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-244-4571
Provider Business Practice Location Address Fax Number:
806-244-5013
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SCHNIEDERJAN
Authorized Official First Name:
KACEY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
806-244-9268

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  000262 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 314000000X , with the licence number: 000262 , 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: 1308264-04 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0007577-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1308264-07 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 130826401 . This is a "SUPERIOR PROF FEES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 130826407 . This is a "SUPERIOR HEALTH HOSP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 131941100 . This is a "FIRST CARE PROF FEES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00C62V . This is a "BCBS CRNA GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00N39T . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 103144100 . This is a "FIRST CARE HOSPITAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1308264-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: AMB527 . This is a "BCBS AMBULANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1308264-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH0041 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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