Healthcare Provider Details

I. General information

NPI: 1083498331
Provider Name (Legal Business Name): PECOS COUNTY MEMORIAL HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 08/18/2023
Certification Date: 08/17/2023
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
US

V. Phone/Fax

Practice location:
  • Phone: 432-345-2508
  • Fax:
Mailing address:
  • Phone: 432-336-2058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BETSY L BRISCOE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 432-336-4201