Provider Demographics
NPI:1295766798
Name:MCCULLOCH COUNTY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:MCCULLOCH COUNTY HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-792-3990
Mailing Address - Street 1:438 E HOUSTON HARTE EXPY
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-4089
Mailing Address - Country:US
Mailing Address - Phone:325-655-7391
Mailing Address - Fax:325-653-1413
Practice Address - Street 1:438 E HOUSTON HARTE EXPY
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-4089
Practice Address - Country:US
Practice Address - Phone:325-655-7391
Practice Address - Fax:325-653-1413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
311500000X, 314000000X
TX127690314000000X, 311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005414OtherTDH CONNECT
TX005414OtherTDH CONNECT
TX001001699Medicaid