MEDICARE: FISHER COUNTY HOSPITAL DIST

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	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	240740	OTHER	TX	CHERYL KELLEY, NP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396726980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FISHER COUNTY HOSPITAL DIST

Provider Business Mailing Address
First Line	:	PO BOX 204
Second Line	:
City	:	JAYTON
State	:	TX
Zip	:	79528-0204
Country	:	US
Telephone Number	:	806-237-3405
Fax Number	:	806-237-2069

Provider Business Practice Location Address
First Line	:	1447 MAIN STREET
Second Line	:
City	:	JAYTON
State	:	TX
Zip	:	79528-2036
Country	:	US
Telephone Number	:	806-237-3405
Fax Number	:	806-237-2069

Authorized Official
Title or Position	:	CLINIC MANAGER
Name	:	MRS. TAMMY R POSEY
Credential	:
Telephone Number	:	325-735-2211

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	09/13/2010

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Directions to “FISHER COUNTY HOSPITAL DIST ” Practice Location

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