Provider Demographics
NPI:1689872020
Name:GPCH, LLC
Entity Type:Organization
Organization Name:GPCH, LLC
Other - Org Name:FRITCH MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:SLATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-467-5700
Mailing Address - Street 1:100 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-7579
Mailing Address - Country:US
Mailing Address - Phone:806-467-5701
Mailing Address - Fax:806-467-5704
Practice Address - Street 1:700 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:FRITCH
Practice Address - State:TX
Practice Address - Zip Code:79036-8754
Practice Address - Country:US
Practice Address - Phone:806-857-2311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRITIAL ACCESS HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-06
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008574261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1930042-01Medicaid
TX1930042-01Medicaid