Provider Demographics
NPI:1366680555
Name:ECTOR COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:ECTOR COUNTY HOSPITAL DISTRICT
Other - Org Name:MCH URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPPEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-640-2413
Mailing Address - Street 1:PO BOX 7239
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-7239
Mailing Address - Country:US
Mailing Address - Phone:432-640-1000
Mailing Address - Fax:432-640-1898
Practice Address - Street 1:3001 JBS PKWY
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-8126
Practice Address - Country:US
Practice Address - Phone:432-640-6700
Practice Address - Fax:432-640-4700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ECTOR COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-27
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135235302Medicaid