Provider Demographics
| NPI: | 1700991700 |
|---|---|
| Name: | MOORE COUNTY HOSPITAL DISTRICT |
| Entity Type: | Organization |
| Organization Name: | MOORE COUNTY HOSPITAL DISTRICT |
| Other - Org Name: | MEMORIAL HOSPITAL |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | JEFF |
| Authorized Official - Middle Name: | R |
| Authorized Official - Last Name: | TURNER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 806-934-7800 |
| Mailing Address - Street 1: | 224 E 2ND ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | DUMAS |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 79029-3808 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 806-935-7171 |
| Mailing Address - Fax: | 806-934-7836 |
| Practice Address - Street 1: | 224 E 2ND ST |
| Practice Address - Street 2: | |
| Practice Address - City: | DUMAS |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 79029-3808 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 806-935-7171 |
| Practice Address - Fax: | 806-934-7836 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-08-20 |
| Last Update Date: | 2022-12-02 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 207Q00000X, 207R00000X, 208000000X, 261QA1903X, 261QR1300X | ||
| TX | 002372 | 251E00000X |
| TX | 002076 | 251G00000X |
| TX | 000199 | 275N00000X, 282NC0060X, 282NR1301X |
| TX | 117334 | 313M00000X |
| TX | 171001 | 341600000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 282NC0060X | Hospitals | General Acute Care Hospital | Critical Access | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Single Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Single Specialty | |
| No | 251E00000X | Agencies | Home Health | ||
| No | 251G00000X | Agencies | Hospice Care, Community Based | ||
| No | 261QA1903X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | |
| No | 261QR1300X | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | |
| No | 275N00000X | Hospital Units | Medicare Defined Swing Bed Unit | ||
| No | 282NR1301X | Hospitals | General Acute Care Hospital | Rural | |
| No | 313M00000X | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | ||
| No | 341600000X | Transportation Services | Ambulance |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | 094129601 | Medicaid | |
| TX | 00593K | Other | PHYSICIAN |
| TX | 451538 | Other | HOSPICE |
| TX | 516828 | Other | AMBULANCE |
| TX | HH9454 | Other | BCBS HOME HEALTH |
| TX | 091665202 | Medicaid | |
| TX | 331607702 | Medicaid | |
| TX | 094129605 | Medicaid | |
| TX | 157069901 | Medicaid | |
| TX | 094129606 | Medicaid | |
| TX | 331607701 | Medicaid | |
| TX | 677531 | Other | HOME HEALTH |
| TX | 000206000 | Medicaid | |
| TX | 094129604 | Medicaid | |
| TX | HH6972 | Other | BCBS HOSPICE |
| TX | 104943100 | Other | FIRSTCARE HOSPITAL ACUTE |
| TX | HH0389 | Other | BCBS HOSPITAL ACUTE |
| TX | 000524901 | Medicaid | |
| TX | 081954201 | Medicaid | |
| TX | 094129602 | Medicaid | |
| TX | 104942100 | Other | FIRSTCARE PHYSICIANS |
| TX | 331607703 | Medicaid | |
| TX | HH0389 | Other | BCBS HOSPITAL ACUTE |
| TX | 104943100 | Other | FIRSTCARE HOSPITAL ACUTE |
| TX | 000524901 | Medicaid | |
| TX | 094129606 | Medicaid | |
| TX | 45U221 | Medicare Oscar/Certification |
