MEDICARE: KIMBLE COUNTY HOSPITAL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician		TX
2	207Q00000X	Family Medicine Physician		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0036HG	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093738981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMBLE COUNTY HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	2101 MAIN ST
Second Line	:
City	:	JUNCTION
State	:	TX
Zip	:	76849-3024
Country	:	US
Telephone Number	:	325-446-3305
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 REID RD
Second Line	:
City	:	JUNCTION
State	:	TX
Zip	:	76849-3008
Country	:	US
Telephone Number	:	325-446-3305
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DONALD FREEMAN
Credential	:
Telephone Number	:	405-878-0202

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	01/13/2009

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Directions to “KIMBLE COUNTY HOSPITAL DISTRICT ” Practice Location

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