Provider Demographics
NPI:1225095441
Name:KNOX COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:KNOX COUNTY HOSPITAL DISTRICT
Other - Org Name:MUNDAY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KUEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-657-3535
Mailing Address - Street 1:PO BOX 420
Mailing Address - Street 2:
Mailing Address - City:MUNDAY
Mailing Address - State:TX
Mailing Address - Zip Code:76371-0420
Mailing Address - Country:US
Mailing Address - Phone:940-422-5271
Mailing Address - Fax:940-422-4251
Practice Address - Street 1:120 E D ST
Practice Address - Street 2:
Practice Address - City:MUNDAY
Practice Address - State:TX
Practice Address - Zip Code:76371-1961
Practice Address - Country:US
Practice Address - Phone:940-422-5271
Practice Address - Fax:940-422-4251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163033701Medicaid
TX163033701OtherTPI
TX163033701OtherTPI
TX00J96XMedicare PIN