Basic Information
| Provider Information | |||||||||
| NPI: | 1801831748 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NACOGDOCHES COUNTY HOSPITAL DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1204 N MOUND ST | ||||||||
| Address2: | |||||||||
| City: | NACOGDOCHES | ||||||||
| State: | TX | ||||||||
| PostalCode: | 759614027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365644611 | ||||||||
| FaxNumber: | 9365688588 | ||||||||
| Practice Location | |||||||||
| Address1: | 1204 N MOUND ST | ||||||||
| Address2: | |||||||||
| City: | NACOGDOCHES | ||||||||
| State: | TX | ||||||||
| PostalCode: | 759614027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365644611 | ||||||||
| FaxNumber: | 9365688588 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 07/29/2019 | ||||||||
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| AuthorizedOfficialLastName: | MCCABE | ||||||||
| AuthorizedOfficialFirstName: | RHONDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9365688525 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | 000478 | TX | Y | Hospitals | General Acute Care Hospital | Rural |
ID Information
| ID | Type | State | Issuer | Description | HH0197 | 01 | TX | BLUE CROSS HOSPITAL | OTHER | 131030203 | 05 | TX | MEDICAID |