1649268152 NPI number — COUNTY OF THROCKMORTON

Table of content: (NPI 1649268152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649268152 NPI number — COUNTY OF THROCKMORTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF THROCKMORTON
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:
HASKELL HEALTHCARE CENTER
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:
1649268152
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
802 N MINTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THROCKMORTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76483-5357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-849-2141
Provider Business Mailing Address Fax Number:
940-849-7141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1504 N 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HASKELL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79521-5438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-864-8537
Provider Business Practice Location Address Fax Number:
940-864-8040
Provider Enumeration Date:
10/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GOBER
Authorized Official First Name:
KIRBY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
940-849-2141

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , 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: 004626 . This is a "FACILITY ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001026130 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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