Iron Mountain Medical Center LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

IRON MOUNTAIN MEDICAL CENTER LLC

Practice address

106 N Grace St
Crockett, TX 75835-1722

Phone

(936) 544-7202

Fax

(936) 546-2029

NPI assigned

Jun 2, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Cynthia Raye Horne, RN

Title

Owner

Phone

(936) 348-9141

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• RHPA dba Iron Mountain Medical Center LLC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1215974688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 N GRACE ST",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758351722",
            "telephone_number": "936-348-9141",
            "fax_number": "936-348-9143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 N GRACE ST",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758351722",
            "telephone_number": "936-544-7202",
            "fax_number": "936-546-2029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRON MOUNTAIN MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HORNE",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "RAYE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "936-348-9141",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0037RB",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PCP",
            "identifier": "138350710",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0051BV",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092386401",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092386403",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RHPA dba Iron Mountain Medical Center LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Crockett, TX
• Providers in Crockett, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.