Provider Demographics
NPI:1598843419
Name:MULESHOE AREA HOSITPAL DISTRICT
Entity Type:Organization
Organization Name:MULESHOE AREA HOSITPAL DISTRICT
Other - Org Name:MEDICAL CLINIC OF MULESHOE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-272-4524
Mailing Address - Street 1:708 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MULESHOE
Mailing Address - State:TX
Mailing Address - Zip Code:79347-3627
Mailing Address - Country:US
Mailing Address - Phone:806-272-4524
Mailing Address - Fax:806-272-4938
Practice Address - Street 1:610 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MULESHOE
Practice Address - State:TX
Practice Address - Zip Code:79347-3625
Practice Address - Country:US
Practice Address - Phone:806-272-7544
Practice Address - Fax:806-272-5155
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MULESHOE AREA HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2010-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000631261Q00000X
TXK7393261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131024502Medicaid
TX00D20NMedicare ID - Type Unspecified
TX451372Medicare Oscar/Certification