Provider Demographics
NPI:1376919977
Name:SHACKELFORD COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:SHACKELFORD COUNTY HOSPITAL DISTRICT
Other - Org Name:SHACKELFORD COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-762-3661
Mailing Address - Street 1:PO BOX 3116
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:TX
Mailing Address - Zip Code:76430
Mailing Address - Country:US
Mailing Address - Phone:325-762-3979
Mailing Address - Fax:325-762-3982
Practice Address - Street 1:104 S. MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:TX
Practice Address - Zip Code:76430
Practice Address - Country:US
Practice Address - Phone:325-762-3979
Practice Address - Fax:325-762-3982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX301173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153911OtherPK
TX148191Medicaid
TX147145Medicaid