- Enrollment id
- O20231005000357
- Enrollment state
- TX
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1043094394
- Multiple npi flag
- N
- Ccn
- 671732
- Associate id
- 3173977477
- Organization name
- PECOS COUNTY MEMORIAL HOSPITAL DISTRICT
- Doing business as name
- PECOS COUNTY MEMORIAL HOSPITAL HOSPICE
- Organization type structure
- OTHER
- Organization other type text
- HOSPITAL DISTRICT
- Proprietary nonprofit
- N
- Address line 1
- 387 W IH 10
- City
- FORT STOCKTON
- State
- TX
- Zip code
- 797352708