Basic Information
| Provider Information | |||||||||
| NPI: | 1427390574 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NIX COMMUNITY GENERAL HOSPITAL, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COMMUNITY GENERAL HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 414 NAVARRO ST STE 600 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782052541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102712190 | ||||||||
| FaxNumber: | 2102712023 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 W MILLER ST | ||||||||
| Address2: | |||||||||
| City: | DILLEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780173818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8309652003 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2013 | ||||||||
| LastUpdateDate: | 01/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | ELDERS | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | JON | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 7147881249 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PROSPECT HOSPITAL HOLDINGS, LLC | ||||||||
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| NPICertificationDate: | 01/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | TX | Y | Hospitals | General Acute Care Hospital |
No ID Information.