Basic Information
| Provider Information | |||||||||
| NPI: | 1427392257 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KNOX COUNTY HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | MUNDAY NURSING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 199 | ||||||||
| Address2: | |||||||||
| City: | MUNDAY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763710199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9404224541 | ||||||||
| FaxNumber: | 9404225244 | ||||||||
| Practice Location | |||||||||
| Address1: | 421 WEST F | ||||||||
| Address2: | |||||||||
| City: | MUNDAY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9404224541 | ||||||||
| FaxNumber: | 9404225244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2012 | ||||||||
| LastUpdateDate: | 11/06/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KUEHLER | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR/CEO | ||||||||
| AuthorizedOfficialTelephone: | 9406573535 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | N | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.