1861510521 NPI number — HARDEMAN COUNTY MEMORIAL HOSP

Table of content: (NPI 1861510521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861510521 NPI number — HARDEMAN COUNTY MEMORIAL HOSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARDEMAN COUNTY MEMORIAL HOSP
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:
1861510521
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 MERCER ST
Provider Second Line Business Mailing Address:
PO BOX 90
Provider Business Mailing Address City Name:
QUANAH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79252-4026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-663-2795
Provider Business Mailing Address Fax Number:
940-663-5149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 MERCER ST
Provider Second Line Business Practice Location Address:
402 MERCER ST
Provider Business Practice Location Address City Name:
QUANAH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79252-4026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-663-2795
Provider Business Practice Location Address Fax Number:
940-663-5149
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BETTS
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
940-663-2795

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  000102 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 000102 , 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: 023961801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121692107 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121692106 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184188401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 091847602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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