MEDICARE: MITCHELL 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	261QR1300X	Rural Health Clinic/Center	75	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00K83J	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518976836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MITCHELL COUNTY HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	997 W INTERSTATE 20
Second Line	:
City	:	COLORADO CITY
State	:	TX
Zip	:	79512-2685
Country	:	US
Telephone Number	:	325-728-8522
Fax Number	:	325-728-2420

Provider Business Practice Location Address
First Line	:	997 W INTERSTATE 20
Second Line	:
City	:	COLORADO CITY
State	:	TX
Zip	:	79512-2685
Country	:	US
Telephone Number	:	325-728-8522
Fax Number	:	325-728-2420

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. ROBERT MURRAY HALL
Credential	:
Telephone Number	:	325-728-8522

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	02/21/2011

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Directions to “MITCHELL COUNTY HOSPITAL DISTRICT ” Practice Location

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