=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346544616
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMANCHE COUNTY MEDICAL CENTER COMPANY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2010
-----------------------------------------------------
Last Update Date | 09/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10201 HIGHWAY 16
-----------------------------------------------------
City | COMANCHE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76442-4462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-879-4900
-----------------------------------------------------
Fax | 254-879-4990
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10201 HIGHWAY 16
-----------------------------------------------------
City | COMANCHE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76442-4462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-879-4900
-----------------------------------------------------
Fax | 254-879-4990
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. DAN BONK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 254-879-4900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | 100123
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 11111
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 275N00000X
-----------------------------------------------------
Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
-----------------------------------------------------
License Number | 100123
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------