Provider Demographics
NPI:1578688834
Name:WILBARGER COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:WILBARGER COUNTY HOSPITAL DISTRICT
Other - Org Name:WILBARGER GENERAL HOSPITAL DIALYSIS OF VERNON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:TOM
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-552-9351
Mailing Address - Street 1:1000 GARLNAD JOHNSTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384
Mailing Address - Country:US
Mailing Address - Phone:940-552-9351
Mailing Address - Fax:940-553-2981
Practice Address - Street 1:1000 GARLAND JOHNSTON DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-4097
Practice Address - Country:US
Practice Address - Phone:940-553-2960
Practice Address - Fax:940-553-2955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH0641OtherBLUE CROSS
TX015021OtherKHC PROVIDER NUMBER
TX158653901Medicaid
OK100703480AMedicaid
TX158653901Medicaid