Provider Demographics
NPI:1437156825
Name:HARDEMAN COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:HARDEMAN COUNTY MEMORIAL HOSPITAL
Other - Org Name:HARDEMAN COUNTY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BETTS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:940-663-2795
Mailing Address - Street 1:PO BOX 90
Mailing Address - Street 2:220 MERCER ST
Mailing Address - City:QUANAH
Mailing Address - State:TX
Mailing Address - Zip Code:79252
Mailing Address - Country:US
Mailing Address - Phone:940-663-6909
Mailing Address - Fax:940-663-5254
Practice Address - Street 1:220 MERCER STREET
Practice Address - Street 2:
Practice Address - City:QUANAH
Practice Address - State:TX
Practice Address - Zip Code:79252
Practice Address - Country:US
Practice Address - Phone:940-663-6909
Practice Address - Fax:940-663-5254
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARDEMAN COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-30
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003242251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX003242OtherTEXAS LICENSE NUMBER
TX023961801Medicaid
TX45DO892565OtherCLIA
TX45DO892565OtherCLIA