Provider Demographics
NPI:1326349986
Name:MID COAST MEDICAL CENTER - CENTRAL
Entity Type:Organization
Organization Name:MID COAST MEDICAL CENTER - CENTRAL
Other - Org Name:MID COAST MEDICAL CENTER - CENTRAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TUDOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-252-1641
Mailing Address - Street 1:200 W OLLIE ST
Mailing Address - Street 2:
Mailing Address - City:LLANO
Mailing Address - State:TX
Mailing Address - Zip Code:78643-2628
Mailing Address - Country:US
Mailing Address - Phone:325-247-5040
Mailing Address - Fax:325-248-2109
Practice Address - Street 1:200 W OLLIE ST
Practice Address - Street 2:
Practice Address - City:LLANO
Practice Address - State:TX
Practice Address - Zip Code:78643-2628
Practice Address - Country:US
Practice Address - Phone:325-247-5040
Practice Address - Fax:325-248-2109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X, 282NC0060X
TX100090282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX220798702OtherMEDICAID ASC
TX220798701Medicaid
TX220798703OtherMEDICAID THSTEPS
TX220798702OtherMEDICAID ASC