Provider Demographics
NPI:1528112356
Name:WISE COUNTY HEALTH SERVICES
Entity type:Organization
Organization Name:WISE COUNTY HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:AMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-683-6370
Mailing Address - Street 1:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:76426-0667
Mailing Address - Country:US
Mailing Address - Phone:940-627-9173
Mailing Address - Fax:940-627-4960
Practice Address - Street 1:800 MEDICAL CENTER DR
Practice Address - Street 2:STE B
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3843
Practice Address - Country:US
Practice Address - Phone:940-627-9173
Practice Address - Fax:940-627-4960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0041617332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1324340001Medicare ID - Type UnspecifiedMEDICARE LICENSE