MEDICARE: CONCHO COUNTY HOSPITAL

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	282NC0060X	Critical Access Hospital

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	116205	OTHER	TX	SUPERIOR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0073GN	OTHER	TX	BLUE CROSS DOCTOR GROUP
5	451325	OTHER	TX	ALL COMMERCIAL INS.
6	HH0527	OTHER	TX	BLUE CROSS HOSPITAL
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326025701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCHO COUNTY HOSPITAL

Provider Business Mailing Address
First Line	:	614 EAKER STREET
Second Line	:
City	:	EDEN
State	:	TX
Zip	:	76837
Country	:	US
Telephone Number	:	325-869-5911
Fax Number	:	325-869-5218

Provider Business Practice Location Address
First Line	:	614 EAKER ST.
Second Line	:
City	:	EDEN
State	:	TX
Zip	:	76837-0987
Country	:	US
Telephone Number	:	325-869-5911
Fax Number	:	325-869-5218

Authorized Official
Title or Position	:	CEO
Name	:	MR. BRIAN LADY
Credential	:
Telephone Number	:	325-869-5911

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	03/17/2020

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1851885016 — CONCHO COUNTY HOSPITAL
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1710989595 — PROVIDER HEALTHCARE SERVICES OF CONCHO LP
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Directions to “CONCHO COUNTY HOSPITAL ” Practice Location

Language	Start Address	Practice Location

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