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	251E00000X	Home Health Agency	001692	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001692	OTHER	TX	LICENSE NUMBER

General Provider Information

NPI Number	:	1861497539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MITCHELL COUNTY HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 454
Second Line	:
City	:	COLORADO CITY
State	:	TX
Zip	:	79512-0454
Country	:	US
Telephone Number	:	325-728-2657
Fax Number	:	325-728-3527

Provider Business Practice Location Address
First Line	:	997 W I 20
Second Line	:
City	:	COLORADO CITY
State	:	TX
Zip	:	79512
Country	:	US
Telephone Number	:	325-728-2657
Fax Number	:	325-728-3527

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. SANDRA ANN GALYEAN
Credential	:	RN
Telephone Number	:	325-728-2657

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	08/22/2020

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Directions to “MITCHELL COUNTY HOSPITAL DISTRICT ” Practice Location

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