Provider Demographics
NPI:1679174882
Name:COMANCHE COUNTY MEDICAL CENTER COMPANY
Entity Type:Organization
Organization Name:COMANCHE COUNTY MEDICAL CENTER COMPANY
Other - Org Name:RISING STAR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HONG
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:254-879-4900
Mailing Address - Street 1:10201 HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:COMANCHE
Mailing Address - State:TX
Mailing Address - Zip Code:76442-4462
Mailing Address - Country:US
Mailing Address - Phone:254-879-4961
Mailing Address - Fax:254-879-4990
Practice Address - Street 1:1870 B STATE HWY 36
Practice Address - Street 2:
Practice Address - City:RISING STAR
Practice Address - State:TX
Practice Address - Zip Code:76471
Practice Address - Country:US
Practice Address - Phone:254-643-3231
Practice Address - Fax:254-540-5060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMANCHE COUNTY MEDICAL CENTER COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-04
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy