Provider Demographics
NPI:1962658302
Name:WILBARGER COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:WILBARGER COUNTY HOSPITAL DISTRICT
Other - Org Name:WILBARGER GENERAL HOSPITAL WESTERN TRAILS BEHAVIORAL UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:TOM
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-552-9351
Mailing Address - Street 1:920 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-3132
Mailing Address - Country:US
Mailing Address - Phone:940-552-9351
Mailing Address - Fax:940-553-2981
Practice Address - Street 1:920 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-3132
Practice Address - Country:US
Practice Address - Phone:940-552-9351
Practice Address - Fax:940-553-2981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000084273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX458423Medicare Oscar/Certification
TX45S584Medicare Oscar/Certification