=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689899072
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCCAMEY COUNTY HOSPITAL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2007
-----------------------------------------------------
Last Update Date | 11/12/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 S HWY 305
-----------------------------------------------------
City | MCCAMEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-652-8626
-----------------------------------------------------
Fax | 432-652-4008
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1200
-----------------------------------------------------
City | MCCAMEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79752-1200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-652-8626
-----------------------------------------------------
Fax | 432-652-4008
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MS. JUDITH A GULIHUR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 432-652-8626
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 00DT94
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 00DT94
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 00DT94
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 00DT94
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 00DT94
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------