Healthcare Provider Details

I. General information

NPI: 1669862876
Provider Name (Legal Business Name): MCCULLOCH COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 MESQUITE PASS
CONVERSE TX
78109-2461
US

IV. Provider business mailing address

7700 MESQUITE PASS
CONVERSE TX
78109-2461
US

V. Phone/Fax

Practice location:
  • Phone: 210-650-0551
  • Fax: 210-650-4472
Mailing address:
  • Phone: 210-650-0551
  • Fax: 210-650-4472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY S JONES
Title or Position: CEO
Credential:
Phone: 325-597-2901