Provider Demographics
NPI:1629610100
Name:CONCHO COUNTY HOSPITAL
Entity Type:Organization
Organization Name:CONCHO COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-869-5911
Mailing Address - Street 1:PO BOX 987
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:TX
Mailing Address - Zip Code:76837-0987
Mailing Address - Country:US
Mailing Address - Phone:325-869-5911
Mailing Address - Fax:
Practice Address - Street 1:3727 W RANCH ROAD 1431
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:TX
Practice Address - Zip Code:78639-3244
Practice Address - Country:US
Practice Address - Phone:325-388-4538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility