Provider Demographics
NPI:1609930999
Name:MATAGORDA COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:MATAGORDA COUNTY HOSPITAL DISTRICT
Other - Org Name:MATAGORDA REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PROCHNOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-245-6383
Mailing Address - Street 1:104 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-4853
Mailing Address - Country:US
Mailing Address - Phone:979-245-6383
Mailing Address - Fax:979-241-5510
Practice Address - Street 1:104 7TH STREET
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-4853
Practice Address - Country:US
Practice Address - Phone:979-245-6383
Practice Address - Fax:979-241-5510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000006273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45S465Medicare ID - Type Unspecified