1255325817 NPI number — MIDLAND COUNTY HOSPITAL DISTRICT

Table of content: (NPI 1255325817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255325817 NPI number — MIDLAND COUNTY HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDLAND 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:
1255325817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 ROSALIND REDFERN GROVER PKWY OFC
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79701-6499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-221-3069
Provider Business Mailing Address Fax Number:
432-685-1190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 ROSALIND REDFERN GROVER PKWY OFC
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79701-6499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-221-3069
Provider Business Practice Location Address Fax Number:
432-685-1190
Provider Enumeration Date:
09/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MEYERS
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
RUSSELL
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
432-221-1584

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  000452 , 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: 136143805 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000452 . This is a "TEXAS DEPT OF HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 136143806 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 136143813 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH0491 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 067901 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 136143804 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104762100 . This is a "FIRST CARE HMO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1739774 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 012467500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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