Provider Demographics
NPI:1023631306
Name:EASTLAND MEMORIAL HOSPITAL DISTRICT
Entity type:Organization
Organization Name:EASTLAND MEMORIAL HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LABAN
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-631-5342
Mailing Address - Street 1:EMH REGIONAL HEALTHCARE CLINIC
Mailing Address - Street 2:304 S. DAUGHERTY STREET
Mailing Address - City:EASTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76448
Mailing Address - Country:US
Mailing Address - Phone:254-631-5342
Mailing Address - Fax:
Practice Address - Street 1:EMH REGIONAL HEALTHCARE CLINIC
Practice Address - Street 2:2314 W. COMMERCE STREET
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448-7644
Practice Address - Country:US
Practice Address - Phone:254-629-5001
Practice Address - Fax:254-629-5010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTLAND MEMORIAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-21
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX423063301Medicaid
TX45D2188296OtherCLIA