Provider Demographics
NPI:1407089386
Name:ALLEGIANCE SPECIALTY HOSPITAL OF KILGORE
Entity Type:Organization
Organization Name:ALLEGIANCE SPECIALTY HOSPITAL OF KILGORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMEED
Authorized Official - Middle Name:A
Authorized Official - Last Name:AKILO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:903-983-4309
Mailing Address - Street 1:1612 S HENDERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-3518
Mailing Address - Country:US
Mailing Address - Phone:903-984-3505
Mailing Address - Fax:
Practice Address - Street 1:1612 S HENDERSON BLVD
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-3518
Practice Address - Country:US
Practice Address - Phone:903-984-3505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26142283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital