Provider Demographics
NPI:1326134255
Name:DIMMIT REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:DIMMIT REGIONAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:830-876-2424
Mailing Address - Street 1:704 HOSPITAL DR
Mailing Address - Street 2:PO BOX 1016
Mailing Address - City:CARRIZO SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78834-3836
Mailing Address - Country:US
Mailing Address - Phone:830-876-2424
Mailing Address - Fax:830-876-5774
Practice Address - Street 1:704 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:CARRIZO SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78834
Practice Address - Country:US
Practice Address - Phone:830-876-2424
Practice Address - Fax:830-876-5774
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIMMIT REGIONAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-05
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX741246262207P00000X
TX741246263208D00000X, 282N00000X
TX100175282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217884005Medicaid
HH0442OtherBCBS
TX112690603Medicaid