Basic Information
| Provider Information | |||||||||
| NPI: | 1417489956 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JACK COUNTY HOSPITAL DISTRICT | ||||||||
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| OtherOrganizationName: | FCH RURAL HEALTH CLINIC BOWIE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 CHISHOLM TRL | ||||||||
| Address2: | |||||||||
| City: | JACKSBORO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 764581403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9405676633 | ||||||||
| FaxNumber: | 9405672895 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 N MILL ST | ||||||||
| Address2: | |||||||||
| City: | BOWIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762303120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9405676633 | ||||||||
| FaxNumber: | 9405672895 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2017 | ||||||||
| LastUpdateDate: | 06/23/2017 | ||||||||
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| AuthorizedOfficialLastName: | BEAMAN | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9405676633 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | 100322 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.