Provider Demographics
NPI:1063681286
Name:COMMUNITY GENERAL HOSPITAL OF DILLEY TEXAS INC
Entity Type:Organization
Organization Name:COMMUNITY GENERAL HOSPITAL OF DILLEY TEXAS INC
Other - Org Name:ESCOBAR CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-334-4016
Mailing Address - Street 1:105 HACKBERRY STREET
Mailing Address - Street 2:
Mailing Address - City:PEARSALL
Mailing Address - State:TX
Mailing Address - Zip Code:78061-4412
Mailing Address - Country:US
Mailing Address - Phone:830-334-4016
Mailing Address - Fax:830-334-4055
Practice Address - Street 1:105 E HACKBERRY ST
Practice Address - Street 2:
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061-4412
Practice Address - Country:US
Practice Address - Phone:830-334-4016
Practice Address - Fax:830-334-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5197208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063446101Medicaid
TX45-8880OtherMEDICARE CCN
B22565Medicare UPIN
453949Medicare Oscar/Certification
TX00JM44Medicare PIN