Provider Demographics
NPI:1053487868
Name:DEWITT MEDICAL DISTRICT
Entity Type:Organization
Organization Name:DEWITT MEDICAL DISTRICT
Other - Org Name:CUERO COMMUNITY HOSPITAL HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOME CARE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:361-275-8999
Mailing Address - Street 1:615 N ESPLANADE ST
Mailing Address - Street 2:
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-3605
Mailing Address - Country:US
Mailing Address - Phone:361-275-8999
Mailing Address - Fax:361-275-8970
Practice Address - Street 1:615 N ESPLANADE ST
Practice Address - Street 2:
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954
Practice Address - Country:US
Practice Address - Phone:361-275-8999
Practice Address - Fax:361-275-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1140251E00000X
251J00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX012280601Medicaid
TX450597OtherOTHER COMMERCIAL INSURANC
TXHH8211OtherBCBS YORKTOWN
TX000635700Medicaid
TXHH9626OtherBCBS TEXAS