Provider Demographics
NPI:1306849633
Name:COUNTY OF YOAKUM
Entity type:Organization
Organization Name:COUNTY OF YOAKUM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-592-2121
Mailing Address - Street 1:415 N AVENUE F
Mailing Address - Street 2:
Mailing Address - City:DENVER CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79323-2741
Mailing Address - Country:US
Mailing Address - Phone:806-592-9501
Mailing Address - Fax:806-592-3052
Practice Address - Street 1:415 N AVENUE F
Practice Address - Street 2:
Practice Address - City:DENVER CITY
Practice Address - State:TX
Practice Address - Zip Code:79323-2741
Practice Address - Country:US
Practice Address - Phone:806-592-9501
Practice Address - Fax:806-592-3052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF YOAKUM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-31
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX458811261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137227810Medicaid
TX0082EVOtherBLUE CROSS/BLUE SHIELD
TX0082EVOtherBLUE CROSS/BLUE SHIELD