Provider Demographics
NPI:1659593028
Name:FALLS COMMUNITY HOSPITAL AND CLINIC
Entity Type:Organization
Organization Name:FALLS COMMUNITY HOSPITAL AND CLINIC
Other - Org Name:FCHC RUCKER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-803-3561
Mailing Address - Street 1:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:MARLIN
Mailing Address - State:TX
Mailing Address - Zip Code:76661-0060
Mailing Address - Country:US
Mailing Address - Phone:254-803-3561
Mailing Address - Fax:254-883-6066
Practice Address - Street 1:200 N PEARL ST
Practice Address - Street 2:
Practice Address - City:MART
Practice Address - State:TX
Practice Address - Zip Code:76664-1142
Practice Address - Country:US
Practice Address - Phone:254-803-3561
Practice Address - Fax:254-883-6066
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FALLS COMMUNITY HOSPITAL AND CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-03
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0892208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167931801Medicaid
TX1679318-01OtherPTAN
TX167931802Medicaid
TX167931802Medicaid