Provider Demographics
NPI:1578891297
Name:HARDEMAN COUNTY MEMORIAL HOSPITAL LLC
Entity Type:Organization
Organization Name:HARDEMAN COUNTY MEMORIAL HOSPITAL LLC
Other - Org Name:HARDEMAN COUNTY MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SLATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-663-5149
Mailing Address - Street 1:402 MERCER ST
Mailing Address - Street 2:
Mailing Address - City:QUANAH
Mailing Address - State:TX
Mailing Address - Zip Code:79252-4026
Mailing Address - Country:US
Mailing Address - Phone:940-663-2795
Mailing Address - Fax:940-663-5149
Practice Address - Street 1:402 MERCER ST
Practice Address - Street 2:
Practice Address - City:QUANAH
Practice Address - State:TX
Practice Address - Zip Code:79252-4026
Practice Address - Country:US
Practice Address - Phone:940-663-2795
Practice Address - Fax:940-663-5149
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRITICAL ACCESS HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000102261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX458848OtherRURAL HEALTH CLINIC - FOARD