Provider Demographics
NPI:1215930342
Name:SHACKELFORD COUNTY RURAL HEALTH
Entity type:Organization
Organization Name:SHACKELFORD COUNTY RURAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JO ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RMC
Authorized Official - Phone:325-762-2892
Mailing Address - Street 1:PO BOX 1567
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:TX
Mailing Address - Zip Code:76430-1567
Mailing Address - Country:US
Mailing Address - Phone:325-762-3661
Mailing Address - Fax:325-762-3859
Practice Address - Street 1:450 KENSHALO ST.
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:TX
Practice Address - Zip Code:76430-1567
Practice Address - Country:US
Practice Address - Phone:325-762-3661
Practice Address - Fax:325-762-3859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5335207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00919NMedicare ID - Type Unspecified