Provider Demographics
NPI:1699844878
Name:BOOKER HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:BOOKER HOSPITAL DISTRICT
Other - Org Name:TEARE MEMORIAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:APRN/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP
Authorized Official - Phone:806-658-4531
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:BOOKER
Mailing Address - State:TX
Mailing Address - Zip Code:79005-0550
Mailing Address - Country:US
Mailing Address - Phone:806-658-4531
Mailing Address - Fax:806-658-9344
Practice Address - Street 1:146 N PIONEER DRIVE
Practice Address - Street 2:
Practice Address - City:BOOKER
Practice Address - State:TX
Practice Address - Zip Code:79005-6008
Practice Address - Country:US
Practice Address - Phone:806-658-4531
Practice Address - Fax:806-658-9344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX652675261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063663101Medicaid
TX063663101Medicaid