Basic Information
| Provider Information | |||||||||
| NPI: | 1679526982 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BROWNWOOD HOSPITAL LP | ||||||||
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| OtherOrganizationName: | BROWNWOOD REGIONAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 848403 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752848403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256468541 | ||||||||
| FaxNumber: | 3256465459 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 BURNET RD | ||||||||
| Address2: | |||||||||
| City: | BROWNWOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 768018520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256468541 | ||||||||
| FaxNumber: | 3256465459 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 08/30/2017 | ||||||||
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| AuthorizedOfficialLastName: | LALOR | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR/DELEGATED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6159254565 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC0050X | N | Ambulatory Health Care Facilities | Clinic/Center | Critical Access Hospital | 282N00000X | 000058 | TX | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 094503202 | 05 | TX | MEDICAID | 127321102 | 05 | TX | MEDICAID | 020930601 | 05 | TX | MEDICAID |