1477791523 NPI number — SMITHVILLE HOSPITAL AUTHORITY

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 1477791523 NPI number — SMITHVILLE HOSPITAL AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMITHVILLE HOSPITAL AUTHORITY
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:
1477791523
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMITHVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78957-9533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
430 OLD AUSTIN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BASTROP
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78602-5168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-321-3527
Provider Business Practice Location Address Fax Number:
512-321-3607
Provider Enumeration Date:
01/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
O
Authorized Official Title or Position:
BOARD PRESIDENT
Authorized Official Telephone Number:
361-652-3331

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  129292 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001026514 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 359975501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5555 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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