Provider Demographics
NPI:1205837770
Name:NORTH RUNNELS COUNTY HOSPITAL
Entity Type:Organization
Organization Name:NORTH RUNNELS COUNTY HOSPITAL
Other - Org Name:NORTH RUNNELS HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-754-1500
Mailing Address - Street 1:7821 STATE HIGHWAY 153
Mailing Address - Street 2:P.O. BOX 185
Mailing Address - City:WINTERS
Mailing Address - State:TX
Mailing Address - Zip Code:79567-7345
Mailing Address - Country:US
Mailing Address - Phone:325-754-4553
Mailing Address - Fax:325-754-5097
Practice Address - Street 1:7821 STATE HIGHWAY 153
Practice Address - Street 2:
Practice Address - City:WINTERS
Practice Address - State:TX
Practice Address - Zip Code:79567-7345
Practice Address - Country:US
Practice Address - Phone:325-754-4553
Practice Address - Fax:325-754-5097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003174251E00000X
TX000151275N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No251E00000XAgenciesHome Health
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20989207Medicaid
TX095134501Medicaid
TX00277TOtherMEDICARE GROUP
TX45-1315Medicare ID - Type Unspecified