Basic Information
| Provider Information | |||||||||
| NPI: | 1881670339 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCCI HOSPITALS OF AMERICA INC | ||||||||
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| OtherOrganizationName: | TRIUMPH HOSPITAL SAN ANGELO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7333 NORTH FWY | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770761300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138078686 | ||||||||
| FaxNumber: | 7138078604 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 E HARRIS AVE | ||||||||
| Address2: | 6TH FLOOR | ||||||||
| City: | SAN ANGELO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 769035904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256593906 | ||||||||
| FaxNumber: | 3256593838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2005 | ||||||||
| LastUpdateDate: | 06/01/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LANFORD | ||||||||
| AuthorizedOfficialFirstName: | VIRGINIA | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | VP, QUALITY AND COMPLIANCE | ||||||||
| AuthorizedOfficialTelephone: | 7138078686 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NEW TRIUMPH HEALTHCARE OF TEXAS LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RN, MBA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | 000819 | TX | Y | Hospitals | Long Term Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 144752601 | 05 | TX | MEDICAID | HH0963 | 01 | TX | BLUE CROSS | OTHER |