Provider Demographics
NPI:1699867853
Name:ELECTRA HOSPITAL DISTRICT
Entity type:Organization
Organization Name:ELECTRA HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-495-3981
Mailing Address - Street 1:111 W CLEVELAND
Mailing Address - Street 2:PO BOX 1112
Mailing Address - City:ELECTRA
Mailing Address - State:TX
Mailing Address - Zip Code:76360
Mailing Address - Country:US
Mailing Address - Phone:940-495-2335
Mailing Address - Fax:940-495-3611
Practice Address - Street 1:111 W CLEVELAND
Practice Address - Street 2:
Practice Address - City:ELECTRA
Practice Address - State:TX
Practice Address - Zip Code:76360
Practice Address - Country:US
Practice Address - Phone:940-495-2335
Practice Address - Fax:940-495-3611
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELECTRA HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-28
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174743336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144535Medicaid
TX1101360001Medicare NSC