Provider Demographics
NPI:1760487284
Name:CROSS TIMBERS HEALTH CLINICS, INC.
Entity Type:Organization
Organization Name:CROSS TIMBERS HEALTH CLINICS, INC.
Other - Org Name:EASTLAND COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:254-893-5895
Mailing Address - Street 1:1100 W REYNOSA AVE
Mailing Address - Street 2:
Mailing Address - City:DE LEON
Mailing Address - State:TX
Mailing Address - Zip Code:76444-1630
Mailing Address - Country:US
Mailing Address - Phone:254-893-5895
Mailing Address - Fax:254-893-5222
Practice Address - Street 1:404 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448-2600
Practice Address - Country:US
Practice Address - Phone:254-893-5895
Practice Address - Fax:254-893-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126862506Medicaid
TX126862506Medicaid