Basic Information
| Provider Information | |||||||||
| NPI: | 1881697878 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | YOAKUM COMMUNITY HOSPITAL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1200 CARL RAMERT DR | ||||||||
| Address2: | |||||||||
| City: | YOAKUM | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779954868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3612932321 | ||||||||
| FaxNumber: | 3612933490 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 CARL RAMERT DR | ||||||||
| Address2: | |||||||||
| City: | YOAKUM | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779954868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3612932321 | ||||||||
| FaxNumber: | 3612933538 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 08/15/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BARBER | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3612932321 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RN | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 000023 | TX | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 112673204 | 05 | TX | MEDICAID | 451346 | 01 | TX | WORKERCOMP | OTHER | 11237202 | 01 | TX | AMERIGROUP | OTHER | 112673202 | 05 | TX | MEDICAID | 500782 | 01 | TX | MHHNP | OTHER |