1396726980 NPI number — FISHER COUNTY HOSPITAL DIST

Table of content: (NPI 1396726980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396726980 NPI number — FISHER COUNTY HOSPITAL DIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FISHER COUNTY HOSPITAL DIST
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:
1396726980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAYTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79528-0204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-237-3405
Provider Business Mailing Address Fax Number:
806-237-2069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1447 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAYTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79528-2036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-237-3405
Provider Business Practice Location Address Fax Number:
806-237-2069
Provider Enumeration Date:
11/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
POSEY
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CLINIC MANAGER
Authorized Official Telephone Number:
325-735-2211

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 240740 . This is a "CHERYL KELLEY, NP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 063619301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 122073302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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