Provider Demographics
NPI:1073579942
Name:PREFERRED HOSPITAL LEASING VAN HORN INC
Entity Type:Organization
Organization Name:PREFERRED HOSPITAL LEASING VAN HORN INC
Other - Org Name:VAN HORN RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-878-0202
Mailing Address - Street 1:EISENHOWER-FM 2185
Mailing Address - Street 2:P.O. BOX 609
Mailing Address - City:VAN HORN
Mailing Address - State:TX
Mailing Address - Zip Code:79855
Mailing Address - Country:US
Mailing Address - Phone:432-283-2760
Mailing Address - Fax:432-283-2581
Practice Address - Street 1:EISENHOWER-FM 2185
Practice Address - Street 2:
Practice Address - City:VAN HORN
Practice Address - State:TX
Practice Address - Zip Code:79855-0609
Practice Address - Country:US
Practice Address - Phone:432-283-2760
Practice Address - Fax:432-283-2581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X, 207Q00000X, 207R00000X
TX261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX453462Medicare Oscar/Certification