Organization
ROCKDALE BLACKHAWK LLC
Active
Other names
Little River Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY P MADISON (CEO)
(512) 446-4500
Entity
Organization
Contact information
Practice address
1700 BRAZOS AVE, ROCKDALE, TX 76567-2517
(512) 446-4500
(512) 446-2063
Mailing address
PO BOX 1010, ROCKDALE, TX 76567-1010
(512) 446-4500
(512) 446-2063
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
282NC0060X
Critical Access Hospital
Primary
000369
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00X082
MEDICARE PART B
TX
05
—
183086101
—
TX
01
—
DF5837
MEDICARE RAIL ROAD
TX
Enumeration date
10/06/2006
Last updated
04/02/2012
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