Provider Demographics
NPI:1063500270
Name:CROSBYTON CLINIC HOSPITAL
Entity Type:Organization
Organization Name:CROSBYTON CLINIC HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-675-2382
Mailing Address - Street 1:710 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROSBYTON
Mailing Address - State:TX
Mailing Address - Zip Code:79322-2143
Mailing Address - Country:US
Mailing Address - Phone:806-675-2382
Mailing Address - Fax:806-675-2645
Practice Address - Street 1:710 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSBYTON
Practice Address - State:TX
Practice Address - Zip Code:79322-2143
Practice Address - Country:US
Practice Address - Phone:806-675-2382
Practice Address - Fax:806-675-2645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X, 282NR1301X
TX000176282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094141105Medicaid
TX094141105Medicaid