MEDICARE: SHACKELFORD 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	3416L0300X	Land Ambulance	209004	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	506003	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1841272366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHACKELFORD COUNTY HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 1507
Second Line	:	432 KENSHALO ST
City	:	ALBANY
State	:	TX
Zip	:	76430-1507
Country	:	US
Telephone Number	:	325-762-3313
Fax Number	:	325-762-2342

Provider Business Practice Location Address
First Line	:	432 KENSHALO ST
Second Line	:
City	:	ALBANY
State	:	TX
Zip	:	76430-1507
Country	:	US
Telephone Number	:	325-762-3313
Fax Number	:	325-762-2342

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	JOANN SHERMAN
Credential	:
Telephone Number	:	325-762-2892

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	08/22/2020

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Directions to “SHACKELFORD COUNTY HOSPITAL DISTRICT ” Practice Location

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