=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295339315
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HASKELL COUNTY HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2020
-----------------------------------------------------
Last Update Date | 10/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 S 1ST ST
-----------------------------------------------------
City | HASKELL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79521-5426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-228-0612
-----------------------------------------------------
Fax | 940-864-2779
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 S 1ST ST
-----------------------------------------------------
City | HASKELL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79521-5426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-228-0612
-----------------------------------------------------
Fax | 904-864-2779
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINIC MANAGER
-----------------------------------------------------
Name | SYDNEY SAUCEDO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 940-228-0612
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------