Provider Demographics
NPI:1538123617
Name:BALLINGER MEMORIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:BALLINGER MEMORIAL HOSPITAL DISTRICT
Other - Org Name:BALLINGER HOSPITAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RHETT
Authorized Official - Middle Name:D
Authorized Official - Last Name:FRICKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-365-2531
Mailing Address - Street 1:P.O. BOX 617
Mailing Address - Street 2:
Mailing Address - City:BALLINGER
Mailing Address - State:TX
Mailing Address - Zip Code:76821-0617
Mailing Address - Country:US
Mailing Address - Phone:325-365-2531
Mailing Address - Fax:325-365-5689
Practice Address - Street 1:2001 HUTCHINS AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:BALLINGER
Practice Address - State:TX
Practice Address - Zip Code:76821-4427
Practice Address - Country:US
Practice Address - Phone:325-365-5737
Practice Address - Fax:325-365-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130089908Medicaid
TX130089911Medicaid
TX130089912Medicaid
TX130089911Medicaid
458867Medicare PIN
TX0L22SOtherBLUECROSS
TX130089911Medicaid