Provider Demographics
NPI:1164685855
Name:GAINESVILLE HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:GAINESVILLE HOSPITAL DISTRICT
Other - Org Name:THE DIALYSIS COTTAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:940-612-8602
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 1:1900 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-2002
Practice Address - Country:US
Practice Address - Phone:940-665-1751
Practice Address - Fax:940-612-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008103261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085989401Medicaid
TX452369Medicare Oscar/Certification