Provider Demographics
NPI:1073749784
Name:SHACKELFORD COUNTY COMMUNITY RESOURCE CENTER
Entity Type:Organization
Organization Name:SHACKELFORD COUNTY COMMUNITY RESOURCE CENTER
Other - Org Name:RESOURCECARE BAIRD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER/CREDENTIALER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-893-4010
Mailing Address - Street 1:PO BOX 2435
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:TX
Mailing Address - Zip Code:76430-8020
Mailing Address - Country:US
Mailing Address - Phone:325-762-2447
Mailing Address - Fax:325-762-2186
Practice Address - Street 1:527 PEYTON STREET
Practice Address - Street 2:
Practice Address - City:BAIRD
Practice Address - State:TX
Practice Address - Zip Code:79504-5314
Practice Address - Country:US
Practice Address - Phone:325-854-1365
Practice Address - Fax:325-854-1409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171901505Medicaid
TX671909Medicare Oscar/Certification