Provider Demographics
NPI:1689659765
Name:PALO PINTO COUNTY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:PALO PINTO COUNTY HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:A
Authorized Official - Last Name:KORKMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-325-7891
Mailing Address - Street 1:400 SW 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-8246
Mailing Address - Country:US
Mailing Address - Phone:940-328-6521
Mailing Address - Fax:940-328-6523
Practice Address - Street 1:202 SW 25TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067
Practice Address - Country:US
Practice Address - Phone:940-328-6521
Practice Address - Fax:940-328-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-12
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
TX261Q00000X
TX34261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111683203Medicaid
TX111683204Medicaid
TX111683204Medicaid