Provider Demographics
NPI:1942314448
Name:COCHRAN MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:COCHRAN MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KODY
Authorized Official - Middle Name:
Authorized Official - Last Name:KITCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-266-5566
Mailing Address - Street 1:201 E GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:TX
Mailing Address - Zip Code:79346-3444
Mailing Address - Country:US
Mailing Address - Phone:806-266-5566
Mailing Address - Fax:806-266-5342
Practice Address - Street 1:201 E GRANT AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:TX
Practice Address - Zip Code:79346-3444
Practice Address - Country:US
Practice Address - Phone:806-266-5566
Practice Address - Fax:806-266-5564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D0507441291U00000X
TX000159282NC0060X, 282NC0060X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094152803Medicaid
TX00R77ROtherBLUE CROSS BLUE SHIELD
TX094152801Medicaid
TX094152803Medicaid