Provider Demographics
NPI:1619303641
Name:LITTLE RIVER HEALTHCARE CENTRAL TEXAS LLC
Entity Type:Organization
Organization Name:LITTLE RIVER HEALTHCARE CENTRAL TEXAS LLC
Other - Org Name:LITTLE RIVER HEALTHCARE CAMERON HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MADISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-446-4500
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:TX
Mailing Address - Zip Code:76520-0191
Mailing Address - Country:US
Mailing Address - Phone:254-605-0025
Mailing Address - Fax:254-605-4353
Practice Address - Street 1:806 N CROCKETT AVE
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:TX
Practice Address - Zip Code:76520-2553
Practice Address - Country:US
Practice Address - Phone:254-605-0025
Practice Address - Fax:254-605-4353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX670094Medicare Oscar/Certification