Provider Demographics
NPI:1144236472
Name:CLAY COUNTY HOSPITAL DME
Entity Type:Organization
Organization Name:CLAY COUNTY HOSPITAL DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-538-5621
Mailing Address - Street 1:310 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:TX
Mailing Address - Zip Code:76365-3346
Mailing Address - Country:US
Mailing Address - Phone:940-538-5621
Mailing Address - Fax:940-538-5220
Practice Address - Street 1:310 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:TX
Practice Address - Zip Code:76365-3346
Practice Address - Country:US
Practice Address - Phone:940-538-5621
Practice Address - Fax:940-538-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0068864332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3951230001Medicare ID - Type Unspecified