Provider Demographics
NPI:1114998911
Name:GRANBURY HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:GRANBURY HOSPITAL CORPORATION
Other - Org Name:LAKE GRANBURY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:PO BOX 844842
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4842
Mailing Address - Country:US
Mailing Address - Phone:817-573-2273
Mailing Address - Fax:
Practice Address - Street 1:1310 PALUXY RD
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5655
Practice Address - Country:US
Practice Address - Phone:817-573-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000424282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
K06782916OtherNHIC MA
TXH04505964Medicaid
0011844OtherHARRIS METH
094178302OtherAMERIGROUP
56125OtherPARKLAND COMM
HASC05969OtherMETROWEST
HH1971OtherBCBS
002308OtherHARRIS METH STAR
5868806OtherAETNA
678291OtherPALMETTO
56125OtherPARKLAND COMM