Provider Demographics
NPI:1134113855
Name:MEDINA COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:MEDINA COUNTY HOSPITAL DISTRICT
Other - Org Name:MEDICAL CLINIC OF HONDO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FROSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-426-5001
Mailing Address - Street 1:3100 AVENUE E
Mailing Address - Street 2:
Mailing Address - City:HONDO
Mailing Address - State:TX
Mailing Address - Zip Code:78861-3534
Mailing Address - Country:US
Mailing Address - Phone:830-426-7700
Mailing Address - Fax:830-426-7860
Practice Address - Street 1:3200 AVENUE E
Practice Address - Street 2:
Practice Address - City:HONDO
Practice Address - State:TX
Practice Address - Zip Code:78861-3525
Practice Address - Country:US
Practice Address - Phone:830-426-7444
Practice Address - Fax:830-426-7468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100046261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2112245-01Medicaid
TX2326068OtherAETNA PROVIDER #
TX0080JSOtherBLUECROSS PROVIDER #
TX2112245-02Medicaid
TX2326068OtherAETNA PROVIDER #
TX082496301Medicaid