NPIMap

Organization Active NPI

Pecos County Memorial Hospital

  • Family Medicine Physician
  • Fort Stockton, TX
National Provider Identifier
1770649295
Registry record updated Nov 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PECOS COUNTY MEMORIAL HOSPITAL
Doing business as
FAMILY CARE CENTER
Practice address
387 Ih 10 W
Ste 1
Fort Stockton, TX 79735-2700
Phone
(432) 336-8365
Fax
(432) 336-8392
NPI assigned
Dec 29, 2006
Organization subpart
Yes
Parent organization
PECOS COUNTY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 8, 2019

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

Authorized official

Name
Ms. Melissa Pena
Title
Director
Phone
(432) 336-4880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

387 Ih 10 W
Ste 1
Fort Stockton, TX 79735-2700

Mailing address

387 Ih 10 W
Ste 1
Fort Stockton, TX 79735-2700
Phone (432) 336-8365

Other identifiers 1

IdentifierTypeStateIssuer
063329901MedicaidTX

Other names 1

  • FAMILY CARE CENTER Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pecos County Memorial4 organizations share this tax ID, including this one
Part of
Pecos County Memorial

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

387 W Ih 10
Ste 1
Fort Stockton, TX 79735
Phone (432) 336-8365

NPI Registry JSON

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573171200000",
    "number": "1770649295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "387 IH 10 W",
            "address_2": "STE 1",
            "city": "FORT STOCKTON",
            "state": "TX",
            "postal_code": "797352700",
            "telephone_number": "432-336-8365",
            "fax_number": "432-336-8392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "387 IH 10 W",
            "address_2": "STE 1",
            "city": "FORT STOCKTON",
            "state": "TX",
            "postal_code": "797352700",
            "telephone_number": "432-336-8365",
            "fax_number": "432-336-8392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECOS COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PECOS COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2006-12-29",
        "last_updated": "2019-11-08",
        "status": "A",
        "authorized_official_last_name": "PENA",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "432-336-4880",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "063329901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FAMILY CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Stockton, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2019; 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.