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General NPI Number Information
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NPI Number | 1215974688
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Entity Type | Organization
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Legal Business Name | IRON MOUNTAIN MEDICAL CENTER LLC
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 106 N GRACE ST
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City | CROCKETT
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State | TX
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Zip | 75835-1722
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Country | US
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Telephone | 936-544-7202
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Fax | 936-546-2029
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Provider Business Mailing Address
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Address Line | 106 N GRACE ST
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City | CROCKETT
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State | TX
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Zip | 75835-1722
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Country | US
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Telephone | 936-348-9141
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Fax | 936-348-9143
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Authorized Official
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Title or Position | OWNER
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Name | CYNTHIA RAYE HORNE
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Credential | RN
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Telephone | 936-348-9141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | TX
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