Provider Demographics
NPI:1760005953
Name:EASTLAND MEMORIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:EASTLAND MEMORIAL HOSPITAL DISTRICT
Other - Org Name:WALNUT STREET CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LABAN
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-631-5342
Mailing Address - Street 1:WALNUT STREET CLINIC
Mailing Address - Street 2:304 S. DAUGHERTY STREET
Mailing Address - City:EASTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76448
Mailing Address - Country:US
Mailing Address - Phone:254-631-5342
Mailing Address - Fax:
Practice Address - Street 1:WALNUT STREET CLINIC
Practice Address - Street 2:200 WALNUT STREET CLINIC
Practice Address - City:RANGER
Practice Address - State:TX
Practice Address - Zip Code:76448-7644
Practice Address - Country:US
Practice Address - Phone:254-647-1182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTLAND MEMORIAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-21
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D0487940OtherCLIA