=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629173737
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FALLS COMMUNITY HOSPITAL AND CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2006
-----------------------------------------------------
Last Update Date | 06/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 307 LIVE OAK ST
-----------------------------------------------------
City | MARLIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76661-2365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-803-3561
-----------------------------------------------------
Fax | 254-883-6066
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 60
-----------------------------------------------------
City | MARLIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76661-0060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-803-3561
-----------------------------------------------------
Fax | 254-883-6066
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INTERIM ADMINISTRATOR
-----------------------------------------------------
Name | MRS. JESSICA FORD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 254-803-3561
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------