Provider Demographics
NPI:1013244318
Name:COLORADO FAYETTE MEDICAL CENTER
Entity Type:Organization
Organization Name:COLORADO FAYETTE MEDICAL CENTER
Other - Org Name:SCHULENBURG COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-725-9531
Mailing Address - Street 1:511 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:SCHULENBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78956-1534
Mailing Address - Country:US
Mailing Address - Phone:979-743-4131
Mailing Address - Fax:979-743-3241
Practice Address - Street 1:511 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:SCHULENBURG
Practice Address - State:TX
Practice Address - Zip Code:78956-1534
Practice Address - Country:US
Practice Address - Phone:979-743-4131
Practice Address - Fax:979-743-3241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX458533Medicare Oscar/Certification