Provider Demographics
NPI:1922057561
Name:GRAHAM HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:GRAHAM HOSPITAL DISTRICT
Other - Org Name:DBA: YOUNG COUNTY FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:DORA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-521-5410
Mailing Address - Street 1:820 MONTGOMERY RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-4200
Mailing Address - Country:US
Mailing Address - Phone:940-549-7741
Mailing Address - Fax:940-549-6265
Practice Address - Street 1:820 MONTGOMERY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-4200
Practice Address - Country:US
Practice Address - Phone:940-549-7741
Practice Address - Fax:940-549-6265
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRAHAM HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-10
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX458851Medicare PIN