Provider Demographics
NPI:1538150370
Name:SOUTH WHEELER COUNTY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:SOUTH WHEELER COUNTY HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FIRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-256-2114
Mailing Address - Street 1:1000 S MAIN ST
Mailing Address - Street 2:P.O. BOX 511
Mailing Address - City:SHAMROCK
Mailing Address - State:TX
Mailing Address - Zip Code:79079-2820
Mailing Address - Country:US
Mailing Address - Phone:806-256-2114
Mailing Address - Fax:806-256-2423
Practice Address - Street 1:1000 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SHAMROCK
Practice Address - State:TX
Practice Address - Zip Code:79079-2820
Practice Address - Country:US
Practice Address - Phone:806-256-2114
Practice Address - Fax:806-256-2423
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAMROCK GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-01
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX571261QR1300X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0921793-01Medicaid
TX0921793-02Medicaid
TX1211930-05Medicaid
TX1211930-05Medicaid
TX45Z340Medicare Oscar/Certification
TX451340Medicare Oscar/Certification