1013970862 NPI number — PREFERRED HOSPITAL LEASING VAN HORN INC

Table of content: (NPI 1013970862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013970862 NPI number — PREFERRED HOSPITAL LEASING VAN HORN INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED HOSPITAL LEASING VAN HORN INC
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:
Provider Other Organization Name Type Code:
6
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:
1013970862
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 609
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VAN HORN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79855-0609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-283-2760
Provider Business Mailing Address Fax Number:
432-283-2581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EISENHOWER-FM 2185
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VAN HORN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-283-2760
Provider Business Practice Location Address Fax Number:
443-228-3258
Provider Enumeration Date:
04/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FREEMAN
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
405-878-0202

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  055001 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 008172 , 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: 184302101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 176354201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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