Basic Information
| Provider Information | |||||||||
| NPI: | 1184618548 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOPKINS COUNTY HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HOPKINS COUNTY MEMORIAL HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 275 | ||||||||
| Address2: | |||||||||
| City: | SULPHUR SPRINGS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754830275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038857671 | ||||||||
| FaxNumber: | 9038854579 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | SULPHUR SPRINGS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754822105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038857671 | ||||||||
| FaxNumber: | 9038854579 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 06/19/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WALLACE | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
| AuthorizedOfficialMiddleName: | GEIKEN | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9034394052 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | Y | Hospitals | General Acute Care Hospital | Rural |
ID Information
| ID | Type | State | Issuer | Description | 7017901 | 05 | TX | MEDICAID | 00C46C | 01 | BLUE CROSS | OTHER | 131037704 | 05 | TX | MEDICAID | 377065600 | 01 | US DEPT OF LABOR | OTHER | 131037702 | 05 | TX | MEDICAID | 4172 | 01 | SSI CLIENT # | OTHER | HH0440 | 01 | BLUE CROSS | OTHER |