Provider Demographics
NPI:1467879569
Name:SEMINOLE HOSPITAL DISTRICT OF GAINES COUNTY TEXAS
Entity Type:Organization
Organization Name:SEMINOLE HOSPITAL DISTRICT OF GAINES COUNTY TEXAS
Other - Org Name:SEMINOLE FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR REVENUE CYCLE HIM
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-758-4951
Mailing Address - Street 1:209 NW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-3447
Mailing Address - Country:US
Mailing Address - Phone:432-758-1155
Mailing Address - Fax:
Practice Address - Street 1:209 NW 8TH ST
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-3447
Practice Address - Country:US
Practice Address - Phone:432-758-5811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094121303Medicaid