1699076257 NPI number — SCOTT & WHITE HOSPITAL - MARBLE FALLS

Table of content: (NPI 1699076257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699076257 NPI number — SCOTT & WHITE HOSPITAL - MARBLE FALLS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOTT & WHITE HOSPITAL - MARBLE FALLS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BAYLOR SCOTT & WHITE CLINIC - LLANO
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699076257
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 844658
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-4339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-724-2111
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 E YOUNG ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78643-1349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-247-4131
Provider Business Practice Location Address Fax Number:
325-247-2562
Provider Enumeration Date:
11/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
OLS
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
830-201-8679

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  100090 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0042WF . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 282267802 . This is a "MEDICAID THSTEPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 282267803 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com