Provider Demographics
NPI:1467628248
Name:PALO PINTO COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:PALO PINTO COUNTY HOSPITAL DISTRICT
Other - Org Name:PALO PINTO RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:A
Authorized Official - Last Name:KORKMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-325-7891
Mailing Address - Street 1:400 SW 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-8246
Mailing Address - Country:US
Mailing Address - Phone:940-325-7891
Mailing Address - Fax:940-328-6523
Practice Address - Street 1:118 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GORDON
Practice Address - State:TX
Practice Address - Zip Code:76453
Practice Address - Country:US
Practice Address - Phone:254-693-5211
Practice Address - Fax:254-693-5774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063500505Medicaid