Healthcare Provider Details

I. General information

NPI: 1730113085
Provider Name (Legal Business Name): PECOS COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 W IH 10
FORT STOCKTON TX
79735
US

IV. Provider business mailing address

387 W IH 10
FORT STOCKTON TX
79735-2700
US

V. Phone/Fax

Practice location:
  • Phone: 432-336-7044
  • Fax: 432-336-2630
Mailing address:
  • Phone: 432-336-7044
  • Fax: 432-336-2630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number009326
License Number StateTX

VIII. Authorized Official

Name: MRS. BETSY BRISCOE
Title or Position: DIRECTOR OF PROVIDER ENROLLMENT
Credential: CEO
Phone: 432-336-4200