=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275581852
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROLLING PLAINS MEMORIAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2006
-----------------------------------------------------
Last Update Date | 07/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 E ARIZONA AVE
-----------------------------------------------------
City | SWEETWATER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79556-7120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-235-1701
-----------------------------------------------------
Fax | 325-235-8705
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 690
-----------------------------------------------------
City | SWEETWATER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79556-0690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-235-1701
-----------------------------------------------------
Fax | 325-235-8705
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. DOUGLAS DIPPEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 325-235-1701
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 275N00000X
-----------------------------------------------------
Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
-----------------------------------------------------
License Number | 000471
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 000471
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 000471
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------