Provider Demographics
NPI:1518032879
Name:LOCKNEY GENERAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:LOCKNEY GENERAL HOSPITAL DISTRICT
Other - Org Name:COGDELL CLINIC BRISCOE COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HEITZENRATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-652-3373
Mailing Address - Street 1:P.O. BOX 37
Mailing Address - Street 2:
Mailing Address - City:LOCKNEY
Mailing Address - State:TX
Mailing Address - Zip Code:79241-0037
Mailing Address - Country:US
Mailing Address - Phone:806-652-3373
Mailing Address - Fax:806-652-2417
Practice Address - Street 1:701 COMMERCE STREET
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:TX
Practice Address - Zip Code:79257
Practice Address - Country:US
Practice Address - Phone:806-652-3373
Practice Address - Fax:806-652-2417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190296701Medicaid
TX190296702Medicaid
TX190296701Medicaid