Provider Demographics
NPI:1184631673
Name:MITCHELL COUNTY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:MITCHELL COUNTY HOSPITAL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-728-3431
Mailing Address - Street 1:997 WEST INTERSTATE 20
Mailing Address - Street 2:
Mailing Address - City:COLORADO CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79512-2685
Mailing Address - Country:US
Mailing Address - Phone:325-728-3431
Mailing Address - Fax:325-728-8974
Practice Address - Street 1:997 WEST INTERSTATE 20
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:TX
Practice Address - Zip Code:79512-2685
Practice Address - Country:US
Practice Address - Phone:325-728-3431
Practice Address - Fax:325-728-8974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336I0012X, 207Q00000X, 208600000X
TX75282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No3336I0012XSuppliersPharmacyInstitutional PharmacyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45Z342OtherSWINGBED PROGRAM FOR CAH
TX136325111Medicaid
TX136325111Medicaid