Healthcare Provider Details

I. General information

NPI: 1194820316
Provider Name (Legal Business Name): PALO PINTO GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/28/2008
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: 940-325-7891
  • Fax: 940-328-6523
Mailing address:
  • Phone: 940-325-7891
  • Fax: 940-328-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number34
License Number StateTX

VIII. Authorized Official

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