Provider Demographics
NPI:1467495184
Name:REFUGIO COUNTY MEMORIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:REFUGIO COUNTY MEMORIAL HOSPITAL DISTRICT
Other - Org Name:WOODSBORO MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WASICEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-526-2321
Mailing Address - Street 1:PO BOX 897
Mailing Address - Street 2:120 WOOD AVE
Mailing Address - City:WOODSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:78393-0897
Mailing Address - Country:US
Mailing Address - Phone:361-543-5414
Mailing Address - Fax:
Practice Address - Street 1:120 WOOD AVE
Practice Address - Street 2:
Practice Address - City:WOODSBORO
Practice Address - State:TX
Practice Address - Zip Code:78393-0897
Practice Address - Country:US
Practice Address - Phone:361-543-5414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REFUGIO COUNTY MEMORIAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-13
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QC0050X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0925273-01Medicaid
TX0925273-02Medicaid
TX0925273-02Medicaid