Healthcare Provider Details

I. General information

NPI: 1891873204
Provider Name (Legal Business Name): COMANCHE COUNTY CONSOLIDATED HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W OAK AVE
COMANCHE TX
76442-3273
US

IV. Provider business mailing address

PO BOX 847
COMANCHE TX
76442-0847
US

V. Phone/Fax

Practice location:
  • Phone: 325-356-2509
  • Fax: 325-356-3716
Mailing address:
  • Phone: 325-356-2509
  • Fax: 325-356-3716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number8047
License Number StateTX

VIII. Authorized Official

Name: WILLIAM EVAN MOORE
Title or Position: CEO
Credential:
Phone: 325-356-2509