Provider Demographics
NPI:1114198496
Name:MITCHELL COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:MITCHELL COUNTY HOSPITAL DISTRICT
Other - Org Name:MITCHELL COUNTY HOSPITAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-728-3431
Mailing Address - Street 1:997 W INTERSTATE 20
Mailing Address - Street 2:
Mailing Address - City:COLORADO CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79512-2685
Mailing Address - Country:US
Mailing Address - Phone:325-728-3431
Mailing Address - Fax:325-728-8974
Practice Address - Street 1:997 W INTERSTATE 20
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:TX
Practice Address - Zip Code:79512-2685
Practice Address - Country:US
Practice Address - Phone:325-728-3431
Practice Address - Fax:325-728-8974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75163W00000X, 207PE0004X, 208600000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00533KOtherMEDICARE GROUP PTAN