Provider Demographics
NPI:1275242489
Name:SOUTH LIMESTONE HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:SOUTH LIMESTONE HOSPITAL DISTRICT
Other - Org Name:RUCKER CLINIC A LIMESTONE MEDICAL CENTER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-729-3281
Mailing Address - Street 1:701 MCCLINTIC DR
Mailing Address - Street 2:
Mailing Address - City:GROESBECK
Mailing Address - State:TX
Mailing Address - Zip Code:76642-2128
Mailing Address - Country:US
Mailing Address - Phone:254-729-3281
Mailing Address - Fax:
Practice Address - Street 1:200 N PEARL ST
Practice Address - Street 2:
Practice Address - City:MART
Practice Address - State:TX
Practice Address - Zip Code:76664-1142
Practice Address - Country:US
Practice Address - Phone:254-729-3281
Practice Address - Fax:254-729-3080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH LIMESTONE HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-16
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access HospitalGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty