Basic Information
| Provider Information | |||||||||
| NPI: | 1457974776 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UVALDE COUNTY HOSPITAL AUTHORITY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1195 GARNER FIELD RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | UVALDE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788014822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302786251 | ||||||||
| FaxNumber: | 8302788873 | ||||||||
| Practice Location | |||||||||
| Address1: | 1195 GARNER FIELD RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | UVALDE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788014822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8304078415 | ||||||||
| FaxNumber: | 8302783359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2020 | ||||||||
| LastUpdateDate: | 05/20/2020 | ||||||||
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| AuthorizedOfficialLastName: | NUTT | ||||||||
| AuthorizedOfficialFirstName: | BRANDI | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN PRACTICE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8302786251 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UVALDE COUNTY HOSPITAL AUTHORITY | ||||||||
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| NPICertificationDate: | 05/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.