Healthcare Provider Details

I. General information

NPI: 1114220928
Provider Name (Legal Business Name): COMANCHE COUNTY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 HIGHWAY 16
COMANCHE TX
76442-4462
US

IV. Provider business mailing address

10201 HIGHWAY 16
COMANCHE TX
76442-4462
US

V. Phone/Fax

Practice location:
  • Phone: 254-879-4900
  • Fax: 254-879-4990
Mailing address:
  • Phone: 254-879-4900
  • Fax: 254-879-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number111111
License Number StateTX

VIII. Authorized Official

Name: NIKKI STARK
Title or Position: COO
Credential:
Phone: 254-879-4900