Provider Demographics
NPI:1679560866
Name:MARTIN COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:MARTIN COUNTY HOSPITAL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-607-3200
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:600 EAST I-20
Mailing Address - City:STANTON
Mailing Address - State:TX
Mailing Address - Zip Code:79782-0640
Mailing Address - Country:US
Mailing Address - Phone:432-607-3200
Mailing Address - Fax:432-607-3265
Practice Address - Street 1:600 EAST I-20
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:TX
Practice Address - Zip Code:79782
Practice Address - Country:US
Practice Address - Phone:432-607-3200
Practice Address - Fax:432-607-3265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100145261QR1300X, 282NC0060X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136145303Medicaid
TX136145310Medicaid
TX136145311Medicaid
TX136145313Medicaid
TX451333Medicare ID - Type Unspecified
TX458868Medicare Oscar/Certification
TX00F74YMedicare PIN