Basic Information
| Provider Information | |||||||||
| NPI: | 1124054069 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANDREWS COUNTY HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ANDREWS FAMILY MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | ANDREWS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797143638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4325236624 | ||||||||
| FaxNumber: | 4325237901 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | ANDREWS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797143638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4325236624 | ||||||||
| FaxNumber: | 4325237901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 08/10/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TIPPIN | ||||||||
| AuthorizedOfficialFirstName: | RUSSELL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4324642101 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ANDREWS COUNTY HOSPITAL DISTRICT | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 000183 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 112273103 | 05 | TX | MEDICAID |