Provider Demographics
NPI:1255429155
Name:NORTH RUNNELS COUNTY HOSPITAL
Entity type:Organization
Organization Name:NORTH RUNNELS COUNTY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-754-1500
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:WINTERS
Mailing Address - State:TX
Mailing Address - Zip Code:79567-0185
Mailing Address - Country:US
Mailing Address - Phone:325-754-1317
Mailing Address - Fax:325-754-1208
Practice Address - Street 1:7571 STATE HIGHWAY 153
Practice Address - Street 2:
Practice Address - City:WINTERS
Practice Address - State:TX
Practice Address - Zip Code:79567-7439
Practice Address - Country:US
Practice Address - Phone:325-754-1317
Practice Address - Fax:325-754-1208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020989204Medicaid
TX020989204Medicaid