Provider Demographics
NPI:1750482055
Name:ELECTRA HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:ELECTRA HOSPITAL DISTRICT
Other - Org Name:ELECTRA MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-495-3981
Mailing Address - Street 1:111 W CLEVELAND AVE
Mailing Address - Street 2:PO BOX 1112
Mailing Address - City:ELECTRA
Mailing Address - State:TX
Mailing Address - Zip Code:76360-2603
Mailing Address - Country:US
Mailing Address - Phone:940-495-4601
Mailing Address - Fax:940-495-4603
Practice Address - Street 1:111 W CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:ELECTRA
Practice Address - State:TX
Practice Address - Zip Code:76360-2603
Practice Address - Country:US
Practice Address - Phone:940-495-4601
Practice Address - Fax:940-495-4603
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELECTRA HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-26
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0037385251E00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011978601Medicaid
TX519855OtherBLUE CROSS #
TX011978601Medicaid