Provider Demographics
NPI:1912982174
Name:PALO PINTO COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:PALO PINTO COUNTY HOSPITAL DISTRICT
Other - Org Name:GORDON FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:WHIDDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-328-6401
Mailing Address - Street 1:400 SW 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-8246
Mailing Address - Country:US
Mailing Address - Phone:940-325-7891
Mailing Address - Fax:940-328-6523
Practice Address - Street 1:118 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GORDON
Practice Address - State:TX
Practice Address - Zip Code:76453
Practice Address - Country:US
Practice Address - Phone:254-693-5211
Practice Address - Fax:940-328-6523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063500501Medicaid
TX458548Medicare Oscar/Certification