Provider Demographics
NPI:1043362908
Name:OCHILTREE HOSPITAL DISTRICT
Entity type:Organization
Organization Name:OCHILTREE HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:JUDICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-435-3606
Mailing Address - Street 1:3101 GARRETT DRIVE
Mailing Address - Street 2:
Mailing Address - City:PERRYTON
Mailing Address - State:TX
Mailing Address - Zip Code:79070-5323
Mailing Address - Country:US
Mailing Address - Phone:806-435-3606
Mailing Address - Fax:806-435-2813
Practice Address - Street 1:3101 GARRETT DRIVE
Practice Address - Street 2:
Practice Address - City:PERRYTON
Practice Address - State:TX
Practice Address - Zip Code:79070-5323
Practice Address - Country:US
Practice Address - Phone:806-435-3606
Practice Address - Fax:806-435-2813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1548207P00000X
TXG2576207P00000X
TXG3581207P00000X
TXG4911207P00000X
TXL9981207P00000X
TXE8078207P00000X
367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121902403Medicaid
TX00J44HMedicare PIN