Provider Demographics
NPI:1093738981
Name:KIMBLE COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:KIMBLE COUNTY HOSPITAL DISTRICT
Other - Org Name:JUNCTION MEDICAL 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 1:2101 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JUNCTION
Mailing Address - State:TX
Mailing Address - Zip Code:76849-3024
Mailing Address - Country:US
Mailing Address - Phone:325-446-3305
Mailing Address - Fax:
Practice Address - Street 1:109 REID RD
Practice Address - Street 2:
Practice Address - City:JUNCTION
Practice Address - State:TX
Practice Address - Zip Code:76849-3008
Practice Address - Country:US
Practice Address - Phone:325-446-3305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0036HGOtherBLUE CROSS BLUE SHIELD
TX091924303Medicaid
TX091924301Medicaid
TX=========OtherTAX ID#
TX091924301Medicaid