Provider Demographics
NPI:1598752404
Name:COMANCHE COUNTY CONSOLIDATED HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:COMANCHE COUNTY CONSOLIDATED HOSPITAL DISTRICT
Other - Org Name:COMANCHE COUNTY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:TROXELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:254-879-4900
Mailing Address - Street 1:10201 HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:COMANCHE
Mailing Address - State:TX
Mailing Address - Zip Code:76442-4462
Mailing Address - Country:US
Mailing Address - Phone:254-879-4900
Mailing Address - Fax:254-879-4990
Practice Address - Street 1:10201 HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:COMANCHE
Practice Address - State:TX
Practice Address - Zip Code:76442-4462
Practice Address - Country:US
Practice Address - Phone:254-879-4900
Practice Address - Fax:254-879-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100123275N00000X, 282NC0060X
TX000495282NR1301X
TX047007341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NR1301XHospitalsGeneral Acute Care HospitalRural
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000335202Medicaid
TX1217846Medicaid
AMB1173Medicare PIN
TX450234Medicare Oscar/Certification
TX1217846Medicaid
TX45Z2382Medicare Oscar/Certification