Basic Information
| Provider Information | |||||||||
| NPI: | 1639239239 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VAL VERDE HOSPITAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 N. BEDELL AVE | ||||||||
| Address2: | |||||||||
| City: | DEL RIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788404112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8307758566 | ||||||||
| FaxNumber: | 8307756632 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 N BEDELL AVE | ||||||||
| Address2: | |||||||||
| City: | DEL RIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788404112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8307758566 | ||||||||
| FaxNumber: | 8307756632 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 06/02/2011 | ||||||||
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| AuthorizedOfficialLastName: | WALTON | ||||||||
| AuthorizedOfficialFirstName: | RON | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR. DIRECTOR PATIENT FINANCIAL SERV | ||||||||
| AuthorizedOfficialTelephone: | 8307758566 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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 | 119877205 | 05 | TX | MEDICAID | 178276100 | 01 | US DEPT OF LABOR | OTHER | CK5555 | 01 | TX | RR MEDICARE | OTHER | 00C73L | 01 | TN | BCBS | OTHER |