Basic Information
| Provider Information | |||||||||
| NPI: | 1629248943 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DALLAM-HARTLEY COUNTIES HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | COON MEMORIAL HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1411 DENVER AVE | ||||||||
| Address2: | |||||||||
| City: | DALHART | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790224809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8062444571 | ||||||||
| FaxNumber: | 8062445013 | ||||||||
| Practice Location | |||||||||
| Address1: | 1411 DENVER AVE | ||||||||
| Address2: | |||||||||
| City: | DALHART | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8062444571 | ||||||||
| FaxNumber: | 8062445013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2008 | ||||||||
| LastUpdateDate: | 07/06/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TAMAYO | ||||||||
| AuthorizedOfficialFirstName: | LOREE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO/ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8062444571 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 000262 | TX | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.