Provider Demographics
NPI:1083745897
Name:LYNN COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:LYNN COUNTY HOSPITAL DISTRICT
Other - Org Name:FAMILY WELLNESS CLINIC NEW HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARMA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ENGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-998-4533
Mailing Address - Street 1:PO BOX 1310
Mailing Address - Street 2:
Mailing Address - City:TAHOKA
Mailing Address - State:TX
Mailing Address - Zip Code:79373-1310
Mailing Address - Country:US
Mailing Address - Phone:806-998-4533
Mailing Address - Fax:806-561-4049
Practice Address - Street 1:1164 FM 211 STE C
Practice Address - Street 2:
Practice Address - City:NEW HOME
Practice Address - State:TX
Practice Address - Zip Code:79381-2302
Practice Address - Country:US
Practice Address - Phone:806-998-4533
Practice Address - Fax:806-561-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
TX000192282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134010100OtherFIRSTCARE
TX8Y0346OtherBLUECROSSBLUESHIELD
TX86N178Medicare ID - Type Unspecified