Basic Information
Provider Information | |||||||||
NPI: | 1437108792 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NHCI OF HILLSBORO INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | HILL REGIONAL HOSPITAL ANESTHESIA | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 101 CIRCLE DR | ||||||||
Address2: |   | ||||||||
City: | HILLSBORO | ||||||||
State: | TX | ||||||||
PostalCode: | 766452670 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2545808951 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 101 CIRCLE DR | ||||||||
Address2: |   | ||||||||
City: | HILLSBORO | ||||||||
State: | TX | ||||||||
PostalCode: | 766452670 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6608265960 | ||||||||
FaxNumber: | 6608264852 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/06/2006 | ||||||||
LastUpdateDate: | 10/13/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SPEIGHT | ||||||||
AuthorizedOfficialFirstName: | REBECCA | ||||||||
AuthorizedOfficialMiddleName: | LEE | ||||||||
AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 4692975336 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | NHCI OF HILLSBORO INC | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/13/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
ID Information
ID | Type | State | Issuer | Description | 00C30H | 01 | TX | BCBS | OTHER | 133252001 | 05 | TX |   | MEDICAID |