Provider Demographics
NPI:1215991039
Name:BALLINGER MEMORIAL HOSPITAL DISTRICT
Entity type:Organization
Organization Name:BALLINGER MEMORIAL HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RHETT
Authorized Official - Middle Name:D
Authorized Official - Last Name:FRICKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-365-2531
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:BALLINGER
Mailing Address - State:TX
Mailing Address - Zip Code:76821-0617
Mailing Address - Country:US
Mailing Address - Phone:325-365-2531
Mailing Address - Fax:325-365-2662
Practice Address - Street 1:608 AVENUE B
Practice Address - Street 2:
Practice Address - City:BALLINGER
Practice Address - State:TX
Practice Address - Zip Code:76821-2406
Practice Address - Country:US
Practice Address - Phone:325-365-2531
Practice Address - Fax:325-365-2662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3001023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130089913Medicaid
AMB1415Medicare Oscar/Certification
TX130089913Medicaid
TX130089913Medicaid