Provider Demographics
NPI:1619978004
Name:NORTH RUNNELS COUNTY HOSPITAL
Entity Type:Organization
Organization Name:NORTH RUNNELS COUNTY HOSPITAL
Other - Org Name:NORTH RUNNELS HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-754-1500
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:WINTERS
Mailing Address - State:TX
Mailing Address - Zip Code:79567-0185
Mailing Address - Country:US
Mailing Address - Phone:325-754-4141
Mailing Address - Fax:325-754-4337
Practice Address - Street 1:500 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WINTERS
Practice Address - State:TX
Practice Address - Zip Code:79567-5824
Practice Address - Country:US
Practice Address - Phone:325-754-4141
Practice Address - Fax:325-754-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003174251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095134501Medicaid
TX41-8191OtherMEDICARE