Provider Demographics
NPI:1396285268
Name:MCCULLOCH COUNTY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:MCCULLOCH COUNTY HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-597-2901
Mailing Address - Street 1:411 S MILLER
Mailing Address - Street 2:
Mailing Address - City:RISING STAR
Mailing Address - State:TX
Mailing Address - Zip Code:76471
Mailing Address - Country:US
Mailing Address - Phone:254-643-6700
Mailing Address - Fax:254-643-1723
Practice Address - Street 1:411 S MILLER ST
Practice Address - Street 2:
Practice Address - City:RISING STAR
Practice Address - State:TX
Practice Address - Zip Code:76471-5214
Practice Address - Country:US
Practice Address - Phone:254-643-6700
Practice Address - Fax:254-643-1723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004327Medicaid
TX675832Medicare Oscar/Certification