Provider Demographics
NPI:1659394617
Name:SAN ANGELO HOSPITAL LP
Entity Type:Organization
Organization Name:SAN ANGELO HOSPITAL LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-925-4565
Mailing Address - Street 1:PO BOX 849051
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-9051
Mailing Address - Country:US
Mailing Address - Phone:325-949-9511
Mailing Address - Fax:325-947-6550
Practice Address - Street 1:3501 KNICKERBOCKER RD
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-7610
Practice Address - Country:US
Practice Address - Phone:325-949-9511
Practice Address - Fax:325-947-6550
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN ANGELO HOSPITAL LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-25
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000056273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112693003Medicaid