1740258417 NPI number — JOURDANTON HOSPITAL CORPORATION

Table of content: (NPI 1740258417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740258417 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:
1740258417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2008
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:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 E THORNTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THREE RIVERS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-786-2626
Provider Business Practice Location Address Fax Number:
361-786-1702
Provider Enumeration Date:
03/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PORTACCI
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VP, GROUP OPERATIONS
Authorized Official Telephone Number:
888-373-9600

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , 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)





Copyright © 2007-2025 www.npivalidator.com