Provider Demographics
NPI:1285631945
Name:TYLER COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:TYLER COUNTY HOSPITAL DISTRICT
Other - Org Name:TCH FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, EDD
Authorized Official - Phone:409-283-6400
Mailing Address - Street 1:104 N BEECH ST
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75979-4718
Mailing Address - Country:US
Mailing Address - Phone:409-283-2822
Mailing Address - Fax:409-283-7852
Practice Address - Street 1:104 N BEECH ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:TX
Practice Address - Zip Code:75979-4718
Practice Address - Country:US
Practice Address - Phone:409-283-2822
Practice Address - Fax:409-283-7852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000569208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0036MDOtherBCBS
TX162059301Medicaid
TX0036MDOtherBCBS