Provider Demographics
NPI:1588672448
Name:COUNTY OF WARD
Entity Type:Organization
Organization Name:COUNTY OF WARD
Other - Org Name:SANDHILLS FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-943-2511
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:MONAHANS
Mailing Address - State:TX
Mailing Address - Zip Code:79756-0040
Mailing Address - Country:US
Mailing Address - Phone:432-943-2068
Mailing Address - Fax:432-943-3114
Practice Address - Street 1:813 E 4TH ST
Practice Address - Street 2:
Practice Address - City:MONAHANS
Practice Address - State:TX
Practice Address - Zip Code:79756-4015
Practice Address - Country:US
Practice Address - Phone:432-943-2068
Practice Address - Fax:432-943-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000468261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0064HDOtherBLUE CROSS BLUE SHIELD TX
TX105864100OtherFIRSTCARE SW HEALTH
TX092075302OtherCHIPS
TX092075302Medicaid
TX092075302Medicaid