Provider Demographics
NPI:1891737920
Name:ANSON HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:ANSON HOSPITAL DISTRICT
Other - Org Name:ANSON FAMILY WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:D
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-823-1152
Mailing Address - Street 1:101 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:ANSON
Mailing Address - State:TX
Mailing Address - Zip Code:79501-2113
Mailing Address - Country:US
Mailing Address - Phone:325-823-3231
Mailing Address - Fax:325-823-3098
Practice Address - Street 1:215 N AVENUE J
Practice Address - Street 2:
Practice Address - City:ANSON
Practice Address - State:TX
Practice Address - Zip Code:79501-2114
Practice Address - Country:US
Practice Address - Phone:325-823-3209
Practice Address - Fax:325-823-3600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANSON HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-12
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000016261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX362063501Medicaid
TX063693801Medicaid
TX127731100OtherFIRSTCARE
TX00J28TOtherBCBS
TX124821OtherSUPERIOR
TX124821OtherSUPERIOR