Basic Information
| Provider Information | |||||||||
| NPI: | 1740238641 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLUMBUS COMMUNITY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 SHULT DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 789343016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9797322371 | ||||||||
| FaxNumber: | 9797329242 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 SHULT DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 789343016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9797322371 | ||||||||
| FaxNumber: | 9797329242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 06/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | VANEK | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9797327561 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 06/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | 000014 | TX | Y | Hospitals | General Acute Care Hospital | Rural |
ID Information
| ID | Type | State | Issuer | Description | 450370 | 01 | TX | MEDICARE | OTHER | 135033204 | 05 | TX | MEDICAID |