Provider Demographics
NPI:1427390574
Name:NIX COMMUNITY GENERAL HOSPITAL, LLC
Entity Type:Organization
Organization Name:NIX COMMUNITY GENERAL HOSPITAL, LLC
Other - Org Name:COMMUNITY GENERAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JON
Authorized Official - Last Name:ELDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-788-1249
Mailing Address - Street 1:414 NAVARRO ST STE 600
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2541
Mailing Address - Country:US
Mailing Address - Phone:210-271-2190
Mailing Address - Fax:210-271-2023
Practice Address - Street 1:230 W MILLER ST
Practice Address - Street 2:
Practice Address - City:DILLEY
Practice Address - State:TX
Practice Address - Zip Code:78017-3818
Practice Address - Country:US
Practice Address - Phone:830-965-2003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROSPECT HOSPITAL HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-26
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
670089Medicare Oscar/Certification