Provider Demographics
NPI:1780786699
Name:PALACIOS COMMUNITY MEDICAL CENTER
Entity type:Organization
Organization Name:PALACIOS COMMUNITY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:ALDEN
Authorized Official - Middle Name:MELOUGH
Authorized Official - Last Name:VANDEVEER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:361-972-2511
Mailing Address - Street 1:311 GREEN AVE
Mailing Address - Street 2:
Mailing Address - City:PALACIOS
Mailing Address - State:TX
Mailing Address - Zip Code:77465-3213
Mailing Address - Country:US
Mailing Address - Phone:361-972-2511
Mailing Address - Fax:361-972-3312
Practice Address - Street 1:311 GREEN AVE
Practice Address - Street 2:
Practice Address - City:PALACIOS
Practice Address - State:TX
Practice Address - Zip Code:77465-3213
Practice Address - Country:US
Practice Address - Phone:361-972-2511
Practice Address - Fax:361-972-3312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000574282NC0060X
282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152686502Medicaid
TX45Z332Medicare Oscar/Certification
TX451332Medicare Oscar/Certification