Provider Demographics
NPI:1174625362
Name:CHILDRESS COUNTY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:CHILDRESS COUNTY HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-937-9178
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:CHILDRESS
Mailing Address - State:TX
Mailing Address - Zip Code:79201-1030
Mailing Address - Country:US
Mailing Address - Phone:940-937-7099
Mailing Address - Fax:940-937-8730
Practice Address - Street 1:910 REAR OAK LANE
Practice Address - Street 2:
Practice Address - City:CHILDRESS
Practice Address - State:TX
Practice Address - Zip Code:79201
Practice Address - Country:US
Practice Address - Phone:940-937-7099
Practice Address - Fax:940-937-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX452385Medicare Oscar/Certification