Healthcare Provider Details

I. General information

NPI: 1518216902
Provider Name (Legal Business Name): PECOS COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 PERSIMMON STREET
SANDERSON TX
79848
US

IV. Provider business mailing address

387 W IH 10
FORT STOCKTON TX
79735-2700
US

V. Phone/Fax

Practice location:
  • Phone: 432-336-2508
  • Fax: 432-345-2426
Mailing address:
  • Phone: 432-336-4213
  • Fax: 432-336-4545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELISSA PENA
Title or Position: DIRECTOR
Credential:
Phone: 432-336-4880