Provider Demographics
NPI:1114047875
Name:THROCKMORTON COUNTY MEMORIAL HOSP
Entity Type:Organization
Organization Name:THROCKMORTON COUNTY MEMORIAL HOSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRBY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOBER
Authorized Official - Suffix:
Authorized Official - Credentials:DVM
Authorized Official - Phone:940-849-2151
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:THROCKMORTON
Mailing Address - State:TX
Mailing Address - Zip Code:76483-0729
Mailing Address - Country:US
Mailing Address - Phone:940-849-2151
Mailing Address - Fax:940-849-7141
Practice Address - Street 1:802 N MINTER AVE STE B
Practice Address - Street 2:
Practice Address - City:THROCKMORTON
Practice Address - State:TX
Practice Address - Zip Code:76483-5357
Practice Address - Country:US
Practice Address - Phone:940-849-2151
Practice Address - Fax:940-849-7141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0635682-02Medicaid
TX0635682-01Medicaid
TX0635682-02Medicaid
TXG70171Medicare UPIN