Provider Demographics
NPI:1346281573
Name:DEWITT MEDICAL DISTRICT
Entity Type:Organization
Organization Name:DEWITT MEDICAL DISTRICT
Other - Org Name:LAMPASAS NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-275-0504
Mailing Address - Street 1:611 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550-1105
Mailing Address - Country:US
Mailing Address - Phone:512-556-3588
Mailing Address - Fax:512-556-2507
Practice Address - Street 1:611 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LAMPASAS
Practice Address - State:TX
Practice Address - Zip Code:76550-1105
Practice Address - Country:US
Practice Address - Phone:512-556-3588
Practice Address - Fax:512-556-2507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115094314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001030472Medicaid
TX001030472Medicaid