Healthcare Provider Details

I. General information

NPI: 1952483307
Provider Name (Legal Business Name): SHACKELFORD COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 KENSHALO
ALBANY TX
76430
US

IV. Provider business mailing address

432 KENSHALO
ALBANY TX
76430
US

V. Phone/Fax

Practice location:
  • Phone: 325-762-3313
  • Fax: 325-762-2342
Mailing address:
  • Phone: 325-762-3313
  • Fax: 325-762-2342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number209004
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number209004
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number209004
License Number StateTX

VIII. Authorized Official

Name: JEFF S DAVIS
Title or Position: BOARD MEMBER
Credential:
Phone: 325-762-3313