Basic Information
| Provider Information | |||||||||
| NPI: | 1760567085 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STARR COUNTY HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | STARR COUNTY MEMORIAL HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 128 N FM 3167 | ||||||||
| Address2: | |||||||||
| City: | RIO GRANDE CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785826211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9564875561 | ||||||||
| FaxNumber: | 9564870131 | ||||||||
| Practice Location | |||||||||
| Address1: | 128 N. FM 3167 | ||||||||
| Address2: | |||||||||
| City: | RIO GRANDE CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785820078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9564875561 | ||||||||
| FaxNumber: | 9564874680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 06/18/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MUNOZ | ||||||||
| AuthorizedOfficialFirstName: | THALIA | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9564875561 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RN, MS | ||||||||
| NPICertificationDate: | 06/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | 000393 | TX | Y | Hospitals | General Acute Care Hospital | Rural |
ID Information
| ID | Type | State | Issuer | Description | 136332705 | 05 | TX | MEDICAID |