Provider Demographics
NPI:1639176456
Name:DALLAM-HARTLEY COUNTIES HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:DALLAM-HARTLEY COUNTIES HOSPITAL DISTRICT
Other - Org Name:COON MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNIEDERJAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-244-9268
Mailing Address - Street 1:PO BOX 2014
Mailing Address - Street 2:
Mailing Address - City:DALHART
Mailing Address - State:TX
Mailing Address - Zip Code:79022-6014
Mailing Address - Country:US
Mailing Address - Phone:806-244-4571
Mailing Address - Fax:806-244-5013
Practice Address - Street 1:1411 DENVER AVE
Practice Address - Street 2:
Practice Address - City:DALHART
Practice Address - State:TX
Practice Address - Zip Code:79022
Practice Address - Country:US
Practice Address - Phone:806-244-4571
Practice Address - Fax:806-244-5013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000262282NC0060X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1308264-04Medicaid
TX0007577-01Medicaid
TX1308264-07Medicaid
130826401OtherSUPERIOR PROF FEES
130826407OtherSUPERIOR HEALTH HOSP
131941100OtherFIRST CARE PROF FEES
TX00C62VOtherBCBS CRNA GROUP
TX00N39TOtherBCBS
103144100OtherFIRST CARE HOSPITAL
TX1308264-01Medicaid
AMB527OtherBCBS AMBULANCE
TX1308264-02Medicaid
HH0041OtherBCBS
HH0041OtherBCBS