Provider Demographics
NPI:1508160706
Name:SCOTT & WHITE HOSPITAL - LLANO
Entity Type:Organization
Organization Name:SCOTT & WHITE HOSPITAL - LLANO
Other - Org Name:SCOTT & WHITE HOSPICE - LLANO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-201-8671
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7788
Mailing Address - Country:US
Mailing Address - Phone:254-724-4090
Mailing Address - Fax:254-215-9322
Practice Address - Street 1:201 BAY WEST BLVD
Practice Address - Street 2:
Practice Address - City:HORSESHOE BAY
Practice Address - State:TX
Practice Address - Zip Code:78657-5200
Practice Address - Country:US
Practice Address - Phone:830-598-5940
Practice Address - Fax:325-247-7899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX671775Medicare Oscar/Certification