MEDICARE: PECOS COUNTY MEMORIAL 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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1205610557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PECOS COUNTY MEMORIAL HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	387 W IH 10
Second Line	:
City	:	FORT STOCKTON
State	:	TX
Zip	:	79735
Country	:	US
Telephone Number	:	432-336-2058
Fax Number	:

Provider Business Practice Location Address
First Line	:	511 N MAIN ST
Second Line	:
City	:	FORT STOCKTON
State	:	TX
Zip	:	79735-5623
Country	:	US
Telephone Number	:	432-336-2291
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	BETSY L BRISCOE
Credential	:
Telephone Number	:	432-336-4201

Provider Enumeration Date	:	08/18/2023
Last Update Date	:	08/18/2023

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Directions to “PECOS COUNTY MEMORIAL HOSPITAL DISTRICT ” Practice Location

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