Provider Demographics
NPI:1174831366
Name:ECTOR COUNTY HOSPTIAL
Entity Type:Organization
Organization Name:ECTOR COUNTY HOSPTIAL
Other - Org Name:RONALD MCDONALD CARE MOBIL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-333-3888
Mailing Address - Street 1:840 W CLEMENTS ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-4601
Mailing Address - Country:US
Mailing Address - Phone:432-333-3888
Mailing Address - Fax:432-640-4887
Practice Address - Street 1:840 W CLEMENTS ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-4601
Practice Address - Country:US
Practice Address - Phone:432-333-3888
Practice Address - Fax:432-640-4887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid