MEDICARE: CONCHO COUNTY HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	000202	TX

General Provider Information

NPI Number	:	1174658025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCHO COUNTY HOSPITAL

Provider Business Mailing Address
First Line	:	614 EAKER STREET
Second Line	:	P.O. BOX 987
City	:	EDEN
State	:	TX
Zip	:	76837-0987
Country	:	US
Telephone Number	:	325-869-5911
Fax Number	:

Provider Business Practice Location Address
First Line	:	614 EAKER STREET
Second Line	:
City	:	EDEN
State	:	TX
Zip	:	76837-0987
Country	:	US
Telephone Number	:	325-869-5911
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRIAN LADY
Credential	:
Telephone Number	:	325-869-5911

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	04/08/2019

Similar Medicare Providers

1326025701 — CONCHO COUNTY HOSPITAL
Practice Location Address:

614 EAKER ST.
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76837-0987

Practice Phone: 325-869-5911
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Practice Location Address:

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1760828966 — RANDALL L. SLOAN, D.O., PLLC
Practice Location Address:

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1851885016 — CONCHO COUNTY HOSPITAL
Practice Location Address:

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1710989595 — PROVIDER HEALTHCARE SERVICES OF CONCHO LP
Practice Location Address:

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Directions to “CONCHO COUNTY HOSPITAL ” Practice Location

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