Healthcare Provider Details

I. General information

NPI: 1891189676
Provider Name (Legal Business Name): COMANCHE COUNTY CONSOLIDATED HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W OAK
COMANCHE TX
76442
US

IV. Provider business mailing address

10201 HWY 16 NORTH
COMANCHE TX
76442
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number008048
License Number StateTX

VIII. Authorized Official

Name: TRACY BURNETT
Title or Position: ADMINISTRATOR
Credential: ADN
Phone: 325-356-2509