MEDICARE: PECOS COUNTY MEMORIAL 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	207Q00000X	Family Medicine Physician
2	261QR1300X	Rural Health Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0079AE	OTHER	TX	MEDICARE PART B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851695316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PECOS COUNTY MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	387 W I H 10
Second Line	:
City	:	FORT STOCKTON
State	:	TX
Zip	:	79735-2700
Country	:	US
Telephone Number	:	432-336-4213
Fax Number	:	432-336-4545

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	:	432-336-4544
Fax Number	:	844-315-6548

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. MELISSA PENA
Credential	:
Telephone Number	:	432-336-4880

Provider Enumeration Date	:	12/27/2010
Last Update Date	:	11/08/2019

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Directions to “PECOS COUNTY MEMORIAL HOSPITAL ” Practice Location

Language	Start Address	Practice Location

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