Provider Demographics
NPI:1346544616
Name:COMANCHE COUNTY MEDICAL CENTER COMPANY
Entity Type:Organization
Organization Name:COMANCHE COUNTY MEDICAL CENTER COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:C
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:ED D
Authorized Official - Phone:254-879-4800
Mailing Address - Street 1:10201 HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:COMANCHE
Mailing Address - State:TX
Mailing Address - Zip Code:76442-4462
Mailing Address - Country:US
Mailing Address - Phone:254-879-4900
Mailing Address - Fax:254-879-4990
Practice Address - Street 1:10201 HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:COMANCHE
Practice Address - State:TX
Practice Address - Zip Code:76442-4462
Practice Address - Country:US
Practice Address - Phone:254-879-4900
Practice Address - Fax:254-879-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100123275N00000X, 282NC0060X
TX11111282N00000X
282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45U234OtherPTAN SB PRIOR 03-31-12
TX450234OtherPTAN PRIOR 03-31-12
TX281406301Medicaid
TX45U234OtherPTAN SB PRIOR 03-31-12