Provider Demographics
NPI:1124372487
Name:GAINESVILLE HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:GAINESVILLE HOSPITAL DISTRICT
Other - Org Name:NTMC OCCUPATIONAL MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:BACUS
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:940-612-8603
Mailing Address - Street 1:1900 HOSPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-2002
Mailing Address - Country:US
Mailing Address - Phone:940-665-1751
Mailing Address - Fax:940-612-8601
Practice Address - Street 1:301 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-4321
Practice Address - Country:US
Practice Address - Phone:940-665-0736
Practice Address - Fax:940-668-8637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00788UMedicare Oscar/Certification