Provider Demographics
NPI:1417051806
Name:ELECTRA HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:ELECTRA HOSPITAL DISTRICT
Other - Org Name:ELECTRA MEMORIAL HOSPITAL CRNA
Other - Org Type:Doing Business As
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:PO BOX 1112
Mailing Address - Street 2:1207 S BAILEY ST
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
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH0728OtherBLUE CROSS
TX135034001Medicaid
TXHH0728OtherBLUE CROSS