Healthcare Provider Details

I. General information

NPI: 1780873117
Provider Name (Legal Business Name): PECOS COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2007
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 I H 10
FORT STOCKTON TX
79735-2700
US

V. Phone/Fax

Practice location:
  • Phone: 432-336-7044
  • Fax: 432-336-2630
Mailing address:
  • Phone: 432-336-2004
  • Fax: 432-336-4545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. RACHELLE RODRIGUEZ
Title or Position: DIRECTOR OF PROVIDER NETWORKS
Credential:
Phone: 432-336-7044