Basic Information
| Provider Information | |||||||||
| NPI: | 1730231853 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OCHILTREE COUNTY HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | OGH MEDICAL EQUIPMENT & SUPPLY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3101 GARRETT DR | ||||||||
| Address2: | |||||||||
| City: | PERRYTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790705323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8064353606 | ||||||||
| FaxNumber: | 8064352813 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 SW 24TH AVE APT 304 | ||||||||
| Address2: | |||||||||
| City: | PERRYTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790705126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8066487500 | ||||||||
| FaxNumber: | 8064352813 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 05/22/2014 | ||||||||
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| AuthorizedOfficialLastName: | STAGGS | ||||||||
| AuthorizedOfficialFirstName: | NATHAN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8064353606 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 38351 | TX | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 010798901 | 05 | TX | MEDICAID |