Provider Demographics
NPI:1184707473
Name:W. WHARTON COUNTY HOSPITAL DISTRICT D B A MID COAST MEDICAL CLINIC PAL
Entity type:Organization
Organization Name:W. WHARTON COUNTY HOSPITAL DISTRICT D B A MID COAST MEDICAL CLINIC PAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-543-5510
Mailing Address - Street 1:310 HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:PALACIOS
Mailing Address - State:TX
Mailing Address - Zip Code:77465-3950
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:310 HENDERSON ST
Practice Address - Street 2:
Practice Address - City:PALACIOS
Practice Address - State:TX
Practice Address - Zip Code:77465-3950
Practice Address - Country:US
Practice Address - Phone:361-972-3664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX458820Medicare UPIN