Provider Demographics
NPI:1871572073
Name:MULESHOE AREA HOSPITAL DISTRICT
Entity type:Organization
Organization Name:MULESHOE AREA HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-272-4524
Mailing Address - Street 1:1100 W AVENUE J
Mailing Address - Street 2:
Mailing Address - City:MULESHOE
Mailing Address - State:TX
Mailing Address - Zip Code:79347-4424
Mailing Address - Country:US
Mailing Address - Phone:806-272-7578
Mailing Address - Fax:806-272-5953
Practice Address - Street 1:1100 W AVENUE J
Practice Address - Street 2:
Practice Address - City:MULESHOE
Practice Address - State:TX
Practice Address - Zip Code:79347-4424
Practice Address - Country:US
Practice Address - Phone:806-272-7578
Practice Address - Fax:806-272-5953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110600314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000421004Medicaid
TX676079Medicare ID - Type Unspecified