Basic Information
| Provider Information | |||||||||
| NPI: | 1639176456 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DALLAM-HARTLEY COUNTIES HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | COON MEMORIAL HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2014 | ||||||||
| Address2: | |||||||||
| City: | DALHART | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790226014 | ||||||||
| 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: | 07/07/2005 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| 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 | 314000000X | 000262 | TX | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility | 282NC0060X | 000262 | TX | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 1308264-04 | 05 | TX | MEDICAID | 0007577-01 | 05 | TX | MEDICAID | 1308264-07 | 05 | TX | MEDICAID | 130826401 | 01 | SUPERIOR PROF FEES | OTHER | 130826407 | 01 | SUPERIOR HEALTH HOSP | OTHER | 131941100 | 01 | FIRST CARE PROF FEES | OTHER | 00C62V | 01 | TX | BCBS CRNA GROUP | OTHER | 00N39T | 01 | TX | BCBS | OTHER | 103144100 | 01 | FIRST CARE HOSPITAL | OTHER | 1308264-01 | 05 | TX | MEDICAID | AMB527 | 01 | BCBS AMBULANCE | OTHER | 1308264-02 | 05 | TX | MEDICAID | HH0041 | 01 | BCBS | OTHER |