Provider Demographics
NPI:1528557410
Name:OCHILTREE HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:OCHILTREE HOSPITAL DISTRICT
Other - Org Name:THE DEWITT FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:JUDICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-435-3606
Mailing Address - Street 1:3101 GARRETT DR
Mailing Address - Street 2:
Mailing Address - City:PERRYTON
Mailing Address - State:TX
Mailing Address - Zip Code:79070-5323
Mailing Address - Country:US
Mailing Address - Phone:806-435-3606
Mailing Address - Fax:806-435-2813
Practice Address - Street 1:3020 GARRETT DR
Practice Address - Street 2:
Practice Address - City:PERRYTON
Practice Address - State:TX
Practice Address - Zip Code:79070-5322
Practice Address - Country:US
Practice Address - Phone:806-648-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX98261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX395971001Medicaid
TX395971002Medicaid
TX101618100OtherFIRSTCARE
TX0097ESOtherBLUE CROSS