Provider Demographics
NPI:1104808112
Name:FISHER COUNTY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:FISHER COUNTY HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-735-2256
Mailing Address - Street 1:774 STATE HWY 70 N
Mailing Address - Street 2:
Mailing Address - City:ROTAN
Mailing Address - State:TX
Mailing Address - Zip Code:79546-6918
Mailing Address - Country:US
Mailing Address - Phone:325-735-2211
Mailing Address - Fax:325-735-2240
Practice Address - Street 1:774 STATE HWY 70 N
Practice Address - Street 2:
Practice Address - City:ROTAN
Practice Address - State:TX
Practice Address - Zip Code:79546-6918
Practice Address - Country:US
Practice Address - Phone:325-735-2211
Practice Address - Fax:325-735-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX108080602Medicaid
TX0015DJOtherBCBS GROUP PROVIDER NUMBER
TX458779Medicare ID - Type UnspecifiedCLEARFORK HEALTH CENTER