Basic Information
| Provider Information | |||||||||
| NPI: | 1801817515 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BROWNWOOD HOSPITAL, LP | ||||||||
| LastName: | |||||||||
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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 DRIVE | ||||||||
| Address2: | |||||||||
| City: | BROWNWOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 768018520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256468541 | ||||||||
| FaxNumber: | 3256465459 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 08/29/2017 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LALOR | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR/DELEGATED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6159254565 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BROWNWOOD HOSPITAL, LP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | 000058 | TX | Y | Hospital Units | Rehabilitation Unit |
ID Information
| ID | Type | State | Issuer | Description | 094503201 | 05 | TX | MEDICAID |