Provider Demographics
NPI:1720072622
Name:MULESHOE AREA HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:MULESHOE AREA HOSPITAL DISTRICT
Other - Org Name:FARWELL MEDICAL CLINIC RHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-272-4524
Mailing Address - Street 1:708 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MULESHOE
Mailing Address - State:TX
Mailing Address - Zip Code:79347-3627
Mailing Address - Country:US
Mailing Address - Phone:806-272-4524
Mailing Address - Fax:806-272-4938
Practice Address - Street 1:301 3RD STREET
Practice Address - Street 2:
Practice Address - City:FARWELL
Practice Address - State:TX
Practice Address - Zip Code:79325
Practice Address - Country:US
Practice Address - Phone:806-481-1000
Practice Address - Fax:806-481-1005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MULESHOE AREA HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-07
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000631261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145855601Medicaid
TX45-8817Medicare ID - Type UnspecifiedFARWELL RHC