Provider Demographics
NPI:1871583153
Name:ELECTRA HOSPITAL DISTRICT
Entity type:Organization
Organization Name:ELECTRA HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-495-3981
Mailing Address - Street 1:1207 S BAILEY ST
Mailing Address - Street 2:PO BOX 1112
Mailing Address - City:ELECTRA
Mailing Address - State:TX
Mailing Address - Zip Code:76360-3221
Mailing Address - Country:US
Mailing Address - Phone:940-495-3981
Mailing Address - Fax:940-495-4215
Practice Address - Street 1:1207 S BAILEY ST
Practice Address - Street 2:
Practice Address - City:ELECTRA
Practice Address - State:TX
Practice Address - Zip Code:76360-3221
Practice Address - Country:US
Practice Address - Phone:940-495-3981
Practice Address - Fax:940-495-4215
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELECTRA HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-26
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000490282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135034009Medicaid
TXHH0728OtherBLUE CROSS ACUTE
TX135034009Medicaid