Provider Demographics
NPI:1508855313
Name:METHODIST HOSPITAL LEVELLAND
Entity Type:Organization
Organization Name:METHODIST HOSPITAL LEVELLAND
Other - Org Name:LEVELLAND CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY FOR ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:425-525-5392
Mailing Address - Street 1:1804 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-6507
Mailing Address - Country:US
Mailing Address - Phone:806-894-3141
Mailing Address - Fax:806-894-7094
Practice Address - Street 1:1804 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336-6507
Practice Address - Country:US
Practice Address - Phone:806-894-3141
Practice Address - Fax:806-894-7094
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METHODIST HOSPITAL LEVELLAND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-14
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000307207Q00000X, 207R00000X, 207V00000X, 208600000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00K60VOtherBCBS
TX107908102OtherFIRSTCARE
TX121337303Medicaid
673988Medicare ID - Type Unspecified