Provider Demographics
NPI:1083619712
Name:GENERAL HOSPITAL
Entity Type:Organization
Organization Name:GENERAL HOSPITAL
Other - Org Name:IRAAN GENERAL HOSPITAL DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:RYBOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-639-2575
Mailing Address - Street 1:PO BOX 665
Mailing Address - Street 2:
Mailing Address - City:IRAAN
Mailing Address - State:TX
Mailing Address - Zip Code:79744-0665
Mailing Address - Country:US
Mailing Address - Phone:432-639-2575
Mailing Address - Fax:432-639-6292
Practice Address - Street 1:600 HWY 349 NORTH
Practice Address - Street 2:
Practice Address - City:IRAAN
Practice Address - State:TX
Practice Address - Zip Code:79744-0665
Practice Address - Country:US
Practice Address - Phone:432-639-2575
Practice Address - Fax:432-639-6292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QC0050X
TX000258282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112728403Medicaid
TX105375100OtherFIRST CARE PROVIDER NUMBE
TX122917OtherSUPERIOR PROVIDER NUMBER
FL9122761-00Medicaid
TXHH0144OtherBLUE CROSS PROVIDER #
TX122917OtherSUPERIOR PROVIDER NUMBER