MEDICARE: COMANCHE COUNTY CONSOLIDATED 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	8047	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01004344	OTHER	TX	TDHS VENDOR NUMBER

General Provider Information

NPI Number	:	1891873204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMANCHE COUNTY CONSOLIDATED HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 847
Second Line	:
City	:	COMANCHE
State	:	TX
Zip	:	76442-0847
Country	:	US
Telephone Number	:	325-356-2509
Fax Number	:	325-356-3716

Provider Business Practice Location Address
First Line	:	108 W OAK AVE
Second Line	:
City	:	COMANCHE
State	:	TX
Zip	:	76442-3273
Country	:	US
Telephone Number	:	325-356-2509
Fax Number	:	325-356-3716

Authorized Official
Title or Position	:	CEO
Name	:	WILLIAM EVAN MOORE
Credential	:
Telephone Number	:	325-356-2509

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	08/22/2020

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1740024488 — DAKOTA ALLEN
Practice Location Address:

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1598752404 — COMANCHE COUNTY CONSOLIDATED HOSPITAL DISTRICT
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Directions to “COMANCHE COUNTY CONSOLIDATED HOSPITAL DISTRICT ” Practice Location

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