Provider Demographics
NPI:1861510521
Name:HARDEMAN COUNTY MEMORIAL HOSP
Entity type:Organization
Organization Name:HARDEMAN COUNTY MEMORIAL HOSP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-663-2795
Mailing Address - Street 1:402 MERCER ST
Mailing Address - Street 2:PO BOX 90
Mailing Address - City:QUANAH
Mailing Address - State:TX
Mailing Address - Zip Code:79252-4026
Mailing Address - Country:US
Mailing Address - Phone:940-663-2795
Mailing Address - Fax:940-663-5149
Practice Address - Street 1:402 MERCER ST
Practice Address - Street 2:402 MERCER ST
Practice Address - City:QUANAH
Practice Address - State:TX
Practice Address - Zip Code:79252-4026
Practice Address - Country:US
Practice Address - Phone:940-663-2795
Practice Address - Fax:940-663-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000102261QR1300X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX023961801Medicaid
TX121692107Medicaid
TX121692106Medicaid
TX184188401Medicaid
TX091847602Medicaid
TX458830Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC
TX184188401Medicaid
TX091847602Medicaid
TX023961801Medicaid
TX451352Medicare ID - Type UnspecifiedCRITICAL CARE HOSPIAL