Basic Information
| Provider Information | |||||||||
| NPI: | 1245353747 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DALLAM-HARTLEY COUNTIES HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COON MEMORIAL HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2014 | ||||||||
| Address2: | |||||||||
| City: | DALHART | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790222014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8062444571 | ||||||||
| FaxNumber: | 8062445013 | ||||||||
| Practice Location | |||||||||
| Address1: | 1411 DENVER AVE | ||||||||
| Address2: | |||||||||
| City: | DALHART | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790222014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8062444571 | ||||||||
| FaxNumber: | 8062445013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | SCHNIEDERJAN | ||||||||
| AuthorizedOfficialFirstName: | KACEY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8062449268 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Y00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology | 208600000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 282NC0060X | 000262 | TX | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.