Basic Information
Provider Information | |||||||||
NPI: | 1639117427 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | COLUMBUS COMMUNITY HOSPITAL | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | HOME HEALTH AGENCY | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 109 SHULT DR | ||||||||
Address2: | SUITE 202 | ||||||||
City: | COLUMBUS | ||||||||
State: | TX | ||||||||
PostalCode: | 789343015 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9797322371 | ||||||||
FaxNumber: | 9797329012 | ||||||||
Practice Location | |||||||||
Address1: | 109 SHULT DR | ||||||||
Address2: | SUITE 202 | ||||||||
City: | COLUMBUS | ||||||||
State: | TX | ||||||||
PostalCode: | 789343015 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9797322371 | ||||||||
FaxNumber: | 9797329012 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/03/2006 | ||||||||
LastUpdateDate: | 07/19/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MUESSE | ||||||||
AuthorizedOfficialFirstName: | DEBBIE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
AuthorizedOfficialTelephone: | 9797322371 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | COLUMBUS COMMUNITY HOSPITAL | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | RN | ||||||||
NPICertificationDate: | 07/19/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | 003088 | TX | N |   | Agencies | Case Management |   | 251F00000X | 003088 | TX | N |   | Agencies | Home Infusion |   | 251J00000X | 003088 | TX | N |   | Agencies | Nursing Care |   | 251V00000X | 003088 | TX | N |   | Agencies | Voluntary or Charitable |   | 251E00000X | 003088 | TX | Y |   | Agencies | Home Health |   |
No ID Information.