Provider Demographics
NPI:1528367356
Name:LIBERTY COUNTY HOSPITAL DISTRICT NO 1
Entity Type:Organization
Organization Name:LIBERTY COUNTY HOSPITAL DISTRICT NO 1
Other - Org Name:LDRMC PROFESSION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-336-7316
Mailing Address - Street 1:1353 N TRAVIS
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TX
Mailing Address - Zip Code:77575-3549
Mailing Address - Country:US
Mailing Address - Phone:936-336-7316
Mailing Address - Fax:936-336-2862
Practice Address - Street 1:1353 N TRAVIS
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-3549
Practice Address - Country:US
Practice Address - Phone:936-336-7316
Practice Address - Fax:936-336-2862
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIBERTY COUNTY HOSPITAL DISTRICT NO 1
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-18
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
TX100072282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB137009Medicare PIN