Healthcare Provider Details

I. General information

NPI: 1629054283
Provider Name (Legal Business Name): PALO PINTO COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SW 25TH AVE
MINERAL WELLS TX
76067-8246
US

IV. Provider business mailing address

400 SW 25TH AVE
MINERAL WELLS TX
76067-8246
US

V. Phone/Fax

Practice location:
  • Phone: 940-328-6403
  • Fax: 940-328-6523
Mailing address:
  • Phone: 940-328-6403
  • Fax: 940-328-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number008490
License Number StateTX

VIII. Authorized Official

Name: MR. HARRIS W BROOKS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 940-328-6403