MEDICARE: IRON MOUNTAIN MEDICAL CENTER LLC

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	207Q00000X	Family Medicine Physician		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0037RB	OTHER	TX	BCBS
2	138350710	OTHER	TX	PCP
3	0051BV	OTHER	TX	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215974688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRON MOUNTAIN MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	106 N GRACE ST
Second Line	:
City	:	CROCKETT
State	:	TX
Zip	:	75835-1722
Country	:	US
Telephone Number	:	936-348-9141
Fax Number	:	936-348-9143

Provider Business Practice Location Address
First Line	:	106 N GRACE ST
Second Line	:
City	:	CROCKETT
State	:	TX
Zip	:	75835-1722
Country	:	US
Telephone Number	:	936-544-7202
Fax Number	:	936-546-2029

Authorized Official
Title or Position	:	OWNER
Name	:	CYNTHIA RAYE HORNE
Credential	:	RN
Telephone Number	:	936-348-9141

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	07/21/2022

Similar Medicare Providers

1942209275 — AFTERCARE VISITING NURSE SERVICE,LLC
Practice Location Address:

106 N GRACE ST
CROCKETT, TX
75835-1722

Practice Phone: 936-544-7202
Practice Fax: 936-546-2029

1811071236 — ACTION02 MEDICAL SUPPLIES,LLC
Practice Location Address:

106 N GRACE ST
CROCKETT, TX
75835-1722

Practice Phone: 936-544-7202
Practice Fax: 936-546-2029

1013301647 — LIFEGUARD AMBULANCE SERVICE OF TEXAS, LLC
Practice Location Address:

1100 E LOOP 304
CROCKETT, TX
75835-1810

Practice Phone: 936-544-4505
Practice Fax:

1891798781 — ROLAND REESE DAIGLE CRNA
Practice Location Address:

1105 E GOLIAD AVE
CROCKETT, TX
75835-2230

Practice Phone: 936-544-4996
Practice Fax: 936-544-4244

1134111263 — CHRISTOPHER R HAECKLER MD
Practice Location Address:

1050 E LOOP 304 , STE 200
CROCKETT, TX
75835-1814

Practice Phone: 936-544-5132
Practice Fax: 936-544-5572

1376535419 — RICHARD JOSEPH KELLY MD
Practice Location Address:

1050 E LOOP 304 , STE 200
CROCKETT, TX
75835-1814

Practice Phone: 936-544-5132
Practice Fax: 936-544-5572

Directions to “IRON MOUNTAIN MEDICAL CENTER LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.