Provider Demographics
NPI:1679797831
Name:JOHNS COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:JOHNS COMMUNITY HOSPITAL
Other - Org Name:DME
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA
Authorized Official - Phone:512-352-4716
Mailing Address - Street 1:305 MALLARD LN
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574-1208
Mailing Address - Country:US
Mailing Address - Phone:512-352-4716
Mailing Address - Fax:512-352-4734
Practice Address - Street 1:305 MALLARD LN
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-1208
Practice Address - Country:US
Practice Address - Phone:512-352-4716
Practice Address - Fax:512-352-4734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0912180001Medicare ID - Type Unspecified