Provider Demographics
NPI:1467482513
Name:MEDICAL HOSPITAL OF BUNA, TEXAS, INC
Entity Type:Organization
Organization Name:MEDICAL HOSPITAL OF BUNA, TEXAS, INC
Other - Org Name:BUNA NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BUTCHEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-994-3576
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:BUNA
Mailing Address - State:TX
Mailing Address - Zip Code:77612-1088
Mailing Address - Country:US
Mailing Address - Phone:409-994-3576
Mailing Address - Fax:409-994-5800
Practice Address - Street 1:34692 US HWY 96S
Practice Address - Street 2:
Practice Address - City:BUNA
Practice Address - State:TX
Practice Address - Zip Code:77612
Practice Address - Country:US
Practice Address - Phone:409-994-3576
Practice Address - Fax:409-994-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116896313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0004480001Medicaid
TX455878Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TX0004480001Medicaid