Basic Information
Provider Information | |||||||||
NPI: | 1275581852 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ROLLING PLAINS MEMORIAL HOSPITAL | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 690 | ||||||||
Address2: |   | ||||||||
City: | SWEETWATER | ||||||||
State: | TX | ||||||||
PostalCode: | 795560690 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3252351701 | ||||||||
FaxNumber: | 3252358705 | ||||||||
Practice Location | |||||||||
Address1: | 200 E ARIZONA AVE | ||||||||
Address2: |   | ||||||||
City: | SWEETWATER | ||||||||
State: | TX | ||||||||
PostalCode: | 795567120 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3252351701 | ||||||||
FaxNumber: | 3252358705 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/05/2006 | ||||||||
LastUpdateDate: | 08/12/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BOATRIGHT | ||||||||
AuthorizedOfficialFirstName: | DONNA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
AuthorizedOfficialTelephone: | 3252351701 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | 000471 | TX | N |   | Hospital Units | Medicare Defined Swing Bed Unit |   | 261QA1903X | 000471 | TX | N |   | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 282N00000X | 000471 | TX | Y |   | Hospitals | General Acute Care Hospital |   |
ID Information
ID | Type | State | Issuer | Description | 133244703 | 05 | TX |   | MEDICAID | 133244705 | 05 | TX |   | MEDICAID |