Provider Demographics
NPI:1841241312
Name:HIGH COUNTRY COMMUNITY RURAL HEALTH CLINIC, LLC
Entity Type:Organization
Organization Name:HIGH COUNTRY COMMUNITY RURAL HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOE ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-249-8324
Mailing Address - Street 1:201 TEXAS BLVD
Mailing Address - Street 2:
Mailing Address - City:DALHART
Mailing Address - State:TX
Mailing Address - Zip Code:79022-1208
Mailing Address - Country:US
Mailing Address - Phone:806-249-8324
Mailing Address - Fax:806-249-8412
Practice Address - Street 1:201 TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:DALHART
Practice Address - State:TX
Practice Address - Zip Code:79022-1208
Practice Address - Country:US
Practice Address - Phone:806-249-8324
Practice Address - Fax:806-249-8412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092278302Medicaid
TX458904Medicare ID - Type UnspecifiedMEDICARE BILLING NUMBER