Provider Demographics
NPI:1609857408
Name:LLANO COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:LLANO COUNTY HOSPITAL AUTHORITY
Other - Org Name:MASON RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEEPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-247-7868
Mailing Address - Street 1:200 W OLLIE ST
Mailing Address - Street 2:
Mailing Address - City:LLANO
Mailing Address - State:TX
Mailing Address - Zip Code:78643-2628
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:216 E COLLEGE
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:TX
Practice Address - Zip Code:76856-1390
Practice Address - Country:US
Practice Address - Phone:325-347-5926
Practice Address - Fax:325-347-5331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0000476261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00298KOtherBCBS
TX171286101Medicaid
TX171286101Medicaid