=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467495598
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCHLEICHER COUNTY MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2006
-----------------------------------------------------
Last Update Date | 02/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 W MURCHISON AVE
-----------------------------------------------------
City | ELDORADO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-853-2507
-----------------------------------------------------
Fax | 325-853-3166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX V
-----------------------------------------------------
City | ELDORADO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76936-1246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-853-2507
-----------------------------------------------------
Fax | 325-853-3166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT BOARD OF DIRECTORS
-----------------------------------------------------
Name | MR. JAMES RANDY MANKIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 325-853-2507
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number | 116222
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------