Provider Demographics
NPI:1326025701
Name:CONCHO COUNTY HOSPITAL
Entity Type:Organization
Organization Name:CONCHO COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-869-5911
Mailing Address - Street 1:614 EAKER STREET
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:TX
Mailing Address - Zip Code:76837
Mailing Address - Country:US
Mailing Address - Phone:325-869-5911
Mailing Address - Fax:325-869-5218
Practice Address - Street 1:614 EAKER ST.
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:TX
Practice Address - Zip Code:76837-0987
Practice Address - Country:US
Practice Address - Phone:325-869-5911
Practice Address - Fax:325-869-5218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116205OtherSUPERIOR
TX091770006Medicaid
TX091770007Medicaid
TX0073GNOtherBLUE CROSS DOCTOR GROUP
TX451325OtherALL COMMERCIAL INS.
TXHH0527OtherBLUE CROSS HOSPITAL
TX091770005Medicaid
TX091770006Medicaid
TX091770007Medicaid
TX451325OtherALL COMMERCIAL INS.
TXC18861Medicare UPIN
TX116205OtherSUPERIOR
TXA67666Medicare UPIN
TX451325Medicare Oscar/Certification