Provider Demographics
NPI:1609814763
Name:COMMUNITY GENERAL HOSPITAL OF DILLEY TEXAS, INC
Entity Type:Organization
Organization Name:COMMUNITY GENERAL HOSPITAL OF DILLEY TEXAS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-697-6591
Mailing Address - Street 1:230 W MILLER ST
Mailing Address - Street 2:
Mailing Address - City:DILLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78017-3818
Mailing Address - Country:US
Mailing Address - Phone:830-965-2003
Mailing Address - Fax:
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000803282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020978501Medicaid
TX020978501Medicaid