Provider Demographics
NPI:1326142712
Name:ELECTRA HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:ELECTRA HOSPITAL DISTRICT
Other - Org Name:ELECTRA MEMORIAL HOSPITAL ER PHYSICIAN
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-495-3981
Mailing Address - Street 1:1207 S BAILEY ST
Mailing Address - Street 2:PO BOX 1112
Mailing Address - City:ELECTRA
Mailing Address - State:TX
Mailing Address - Zip Code:76360-1112
Mailing Address - Country:US
Mailing Address - Phone:940-495-3981
Mailing Address - Fax:940-495-4137
Practice Address - Street 1:1207 S BAILEY ST
Practice Address - Street 2:
Practice Address - City:ELECTRA
Practice Address - State:TX
Practice Address - Zip Code:76360-1112
Practice Address - Country:US
Practice Address - Phone:940-495-3981
Practice Address - Fax:940-495-4137
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELECTRA HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-07
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134035003Medicaid
TX0077BDMedicare PIN