1558349399 NPI number — HEART OF TEXAS HEALTHCARE SYSTEM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558349399 NPI number — HEART OF TEXAS HEALTHCARE SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART OF TEXAS HEALTHCARE SYSTEM
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:
HEART OF TEXAS MEMORIAL HOSPITAL
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:
1558349399
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRADY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76825-1150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-597-2901
Provider Business Mailing Address Fax Number:
325-597-2280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2008 NINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76825-7210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-597-2901
Provider Business Practice Location Address Fax Number:
325-597-2280
Provider Enumeration Date:
01/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
TIM
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
325-597-2901

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  000362 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NR1301X , 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: 138715115 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 322916301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH0156 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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