Healthcare Provider Details

I. General information

NPI: 1679174882
Provider Name (Legal Business Name): COMANCHE COUNTY MEDICAL CENTER COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 08/31/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 B STATE HWY 36
RISING STAR TX
76471
US

IV. Provider business mailing address

10201 HIGHWAY 16
COMANCHE TX
76442-4462
US

V. Phone/Fax

Practice location:
  • Phone: 254-643-3231
  • Fax: 254-540-5060
Mailing address:
  • Phone: 254-879-4961
  • Fax: 254-879-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HONG WADE
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 254-879-4900