Provider Demographics
NPI:1134720931
Name:COMANCHE COUNTY MEDICAL CENTER COMPANY
Entity type:Organization
Organization Name:COMANCHE COUNTY MEDICAL CENTER COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINIC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-879-4910
Mailing Address - Street 1:10201 HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:COMANCHE
Mailing Address - State:TX
Mailing Address - Zip Code:76442-4462
Mailing Address - Country:US
Mailing Address - Phone:254-879-4900
Mailing Address - Fax:254-879-4991
Practice Address - Street 1:1870 STATE HWY 36
Practice Address - Street 2:
Practice Address - City:RISING STAR
Practice Address - State:TX
Practice Address - Zip Code:76471
Practice Address - Country:US
Practice Address - Phone:254-879-4900
Practice Address - Fax:254-879-4991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMANCHE COUNTY MEDICAL CENTER COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-06
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health