Provider Demographics
NPI:1760598692
Name:PECOS COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:PECOS COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRISCOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-336-4200
Mailing Address - Street 1:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:FORT STOCKTON
Mailing Address - State:TX
Mailing Address - Zip Code:79735-1648
Mailing Address - Country:US
Mailing Address - Phone:432-336-2004
Mailing Address - Fax:432-336-4545
Practice Address - Street 1:387 W IH 10
Practice Address - Street 2:
Practice Address - City:FORT STOCKTON
Practice Address - State:TX
Practice Address - Zip Code:79735-2700
Practice Address - Country:US
Practice Address - Phone:432-336-2004
Practice Address - Fax:432-336-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000356282NC0060X, 282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130616909Medicaid
TX596656OtherJOINT COMMISSION ID
TX130616910Medicaid
TXHH0479OtherBLUE CROSS BLUE SHIELD TX
TX000356OtherHOSPITAL LICENSE NUMBER
TX130616911Medicaid
TX000356OtherHOSPITAL LICENSE NUMBER