Provider Demographics
NPI:1558715201
Name:ECTOR COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:ECTOR COUNTY HOSPITAL DISTRICT
Other - Org Name:MCH FAMILY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-640-4868
Mailing Address - Street 1:6030 W UNIVERSITY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79764-8530
Mailing Address - Country:US
Mailing Address - Phone:432-640-6600
Mailing Address - Fax:432-640-4776
Practice Address - Street 1:6030 W UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79764-8530
Practice Address - Country:US
Practice Address - Phone:432-640-6600
Practice Address - Fax:432-640-4791
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ECTOR COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-19
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091952402Medicaid
TX366000301Medicaid
TX091952401Medicaid
TX135235310Medicaid
TX091952402Medicaid
TX1750345088Medicaid
TX135235310Medicaid
TX600401OtherLICENSE NUMBER
TX091952402Medicaid
TX00R44WMedicare PIN
TX1750345088Medicaid