Provider Demographics
NPI:1770649295
Name:PECOS COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:PECOS COUNTY MEMORIAL HOSPITAL
Other - Org Name:FAMILY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-336-4880
Mailing Address - Street 1:387 IH 10 W
Mailing Address - Street 2:STE 1
Mailing Address - City:FORT STOCKTON
Mailing Address - State:TX
Mailing Address - Zip Code:79735-2700
Mailing Address - Country:US
Mailing Address - Phone:432-336-8365
Mailing Address - Fax:432-336-8392
Practice Address - Street 1:387 IH 10 W
Practice Address - Street 2:STE 1
Practice Address - City:FORT STOCKTON
Practice Address - State:TX
Practice Address - Zip Code:79735-2700
Practice Address - Country:US
Practice Address - Phone:432-336-8365
Practice Address - Fax:432-336-8392
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PECOS COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-29
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063329901Medicaid