Healthcare Provider Details

I. General information

NPI: 1437156361
Provider Name (Legal Business Name): COUNTY OF CLAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W SOUTH ST
HENRIETTA TX
76365-3346
US

IV. Provider business mailing address

310 W SOUTH ST
HENRIETTA TX
76365-3346
US

V. Phone/Fax

Practice location:
  • Phone: 940-538-5621
  • Fax: 940-235-1215
Mailing address:
  • Phone: 940-538-5621
  • Fax: 940-235-1215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number000193
License Number StateTX

VIII. Authorized Official

Name: MS. LISA SWENSON
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 940-235-1200