Provider Demographics
NPI:1447325543
Name:KNOX COUNTY HOSPITAL
Entity type:Organization
Organization Name:KNOX COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-657-3906
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:712 S 5TH
Mailing Address - City:KNOX CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79529-0488
Mailing Address - Country:US
Mailing Address - Phone:940-657-3906
Mailing Address - Fax:940-657-3909
Practice Address - Street 1:712 SE 5TH ST
Practice Address - Street 2:
Practice Address - City:KNOX CITY
Practice Address - State:TX
Practice Address - Zip Code:79529-2105
Practice Address - Country:US
Practice Address - Phone:940-657-3906
Practice Address - Fax:940-657-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J96XOtherBLUE CROSS BLUE SHIELD
TX00J96XMedicare ID - Type Unspecified