Provider Demographics
NPI:1861678880
Name:FAYETTE COUNTY
Entity Type:Organization
Organization Name:FAYETTE COUNTY
Other - Org Name:INDIGENT HEALTH CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:COUNTY JUDGE
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:JANECKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-968-6469
Mailing Address - Street 1:151 N WASHINGTON ST RM 301
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-2657
Mailing Address - Country:US
Mailing Address - Phone:979-968-6469
Mailing Address - Fax:979-968-8621
Practice Address - Street 1:151 N WASHINGTON ST RM 301
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945
Practice Address - Country:US
Practice Address - Phone:979-968-6469
Practice Address - Fax:979-968-8621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization