Healthcare Provider Details

I. General information

NPI: 1962385682
Provider Name (Legal Business Name): FANNIN COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 MARTIN LUTHER KING BLVD
LUBBOCK TX
79403-5213
US

IV. Provider business mailing address

507 MARTIN LUTHER KING BLVD
LUBBOCK TX
79403-5213
US

V. Phone/Fax

Practice location:
  • Phone: 806-744-1113
  • Fax: 806-744-1060
Mailing address:
  • Phone: 806-744-1113
  • Fax: 806-744-1060

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: CLARK SANDERSON
Title or Position: BOARD PRESIDENT
Credential:
Phone: 817-372-7224