1184695785 NPI number — JOURDANTON HOSPITAL CORPORATION

Table of content: (NPI 1184695785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184695785 NPI number — JOURDANTON HOSPITAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOURDANTON HOSPITAL CORPORATION
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:
1184695785
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 847974
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:
75284-7974
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-769-3515
Provider Business Mailing Address Fax Number:
830-769-5264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1905 HIGHWAY 97 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOURDANTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78026-1504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-769-3515
Provider Business Practice Location Address Fax Number:
830-769-5264
Provider Enumeration Date:
01/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOLTSFORD
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
615-465-7466

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  000334 , 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: 178476300 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 121780403 . This is a "CHILDRENS SPECIAL NEEDS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 121780403 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121780402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 620010 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 450165 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: HH0154 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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