Provider Demographics
NPI:1356418974
Name:THROCKMORTON COUNTY MEMORIAL HOSP
Entity type:Organization
Organization Name:THROCKMORTON COUNTY MEMORIAL HOSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRBY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOBER
Authorized Official - Suffix:
Authorized Official - Credentials:DVM
Authorized Official - Phone:940-849-2151
Mailing Address - Street 1:802 N MINTER AVE
Mailing Address - Street 2:PO BOX 729
Mailing Address - City:THROCKMORTON
Mailing Address - State:TX
Mailing Address - Zip Code:76483-5375
Mailing Address - Country:US
Mailing Address - Phone:940-849-2151
Mailing Address - Fax:940-849-7141
Practice Address - Street 1:802 N MINTER AVE
Practice Address - Street 2:
Practice Address - City:THROCKMORTON
Practice Address - State:TX
Practice Address - Zip Code:76483-5375
Practice Address - Country:US
Practice Address - Phone:940-849-2151
Practice Address - Fax:940-849-7141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000428282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0881898-03Medicaid
TX0881898-03Medicaid
458683Medicare ID - Type Unspecified
G70171Medicare UPIN
45Z339Medicare ID - Type Unspecified